Chronic II- final practice questions

A nurse determines that the wife of an alcoholic client is benefiting from attending as Al-anon group when the nurse hears the wife say: A. "I no longer feel that I deserve the beatings my husband inflicts on me." B. "My attendance at the meetings has helped me to see that I provoke my husband's violence." C. "I enjoy attending the meetings because they get me out of the house and away from my husband." D. "I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics."

A. "I no longer feel that I deserve the beatings my husband inflicts on me."

The mother of the 14 year old tells the clinic nurse that she is concerned that her child may be "doing some sort of drugs". The adolescent is confused and has difficulty answering questions clearly but admits to sniffing solvents in the family garage. Which statement by the nurse is correct? A. "Most inhalants can cause serious nervous system and respiratory system damage." B. "There is a little risk for physical harm; the effects will wear off within a few hours" C. "Your seeking help early can discourage your child from future drug experimentation" D. "Due to hyperactivity now, you will sleep for long periods after the drug effects are gone."

A. "Most inhalants can cause serious nervous system and respiratory system damage." Why A? It's an emergent thing, it's not something you can ignore for now.

The hospitalized client has a hx of weekly moderate alcohol use. Which symptoms assessed by the nurse indicate the client may be experiencing alcohol withdrawal? Select all that apply. A. Agitation B. Hypotension C. Tachycardia D. Hallucination E. Tongue tremor

A. Agitation C. Tachycardia D. Hallucination

The client with a history of poly substance abuse is being medically detoxified in an acute care hospital. The client reported recently using alcohol, oxycodone, crack cocaine, and marijuana. In planning for detoxification, which substance for detoxification if the nurse's priority? A. Alcohol B. Marijuana C. Oxycodone D. Crack cocaine

A. Alcohol Think about severity. We're talking about withdrawal. Why not D? It's not as dangerous for withdrawal. Alcohol is the worst/most dangerous for withdrawal. You can die. What is also bad (about the same level as alcohol)? Benzos, but it's not a choice to pick here. Alcohol and benzos both inhibit GABA.

Which of the following nursing actions is contraindicated for the client who is experiencing severe symptoms of alcohol withdrawal? A. Ambulating the client B. Monitoring I/Os C. Assessing vital signs D. Using short, concrete statements

A. Ambulating the client

A client who reports seeing "pink elephants on the wall", hearing voices, constantly picking at the face and hands, stating "people are out to kill me," and has a BP of 168/90 is admitted. The nurse assesses this client to be experiencing which of the following?" A. Amphetamine toxicity B. Opioid withdrawal C. Inhalant side effects D. Alcohol dependence

A. Amphetamine toxicity

The priority nursing intervention in caring for a client experiencing flashbacks from hallucinogenic intoxication includes A. Assisting the client with anxiety reduction B. Exploring relapse triggers with the client C. Providing interpersonal skills training D. Teaching the client the medical consequences of hallucinogen abuse

A. Assisting the client with anxiety reduction Everything else requires a little more attention. They're experiencing flashbacks currently too, so A would be most correct.

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and beings to walk out of the hospital room. Which action should the nurse take? A. Call the nursing supervisor. B. Call the security to block all exit areas C. Restrain the client until the health care provider can be reached D. Tell the client that the client can't return to this hospital again if the client leaves now.

A. Call the nursing supervisor. Why not B? Security can't block them leaving. Why not C? False imprisonment. Why not D? You can't tell them they can't come back to the hospital. You can ban people for bringing guns or if they're high on meth or something, but not in this case.

The 19 year old client regularly abuses dextromethorphan (DXM). Which activity, if performed under the influence of dextromethorphan, places the client at highest risk for complications related to DXM abuse? A. Dancing at a night club B. Competing in a swim meet C. Snow-skiing on spring break D. Fishing from a shaded shoreline

A. Dancing at a night club Hyperthermia is the issue to watch for. You're going to sweat when you're dancing. No other choices will cause sweating. In this case when you're not sure if temp is the main issue to watch out for/what to even watch out for, try to narrow it down to 2 answers, OR try to see patterns in the answer choices and try to pick out one that stands out.

The nurse is caring for the client who has methamphetamine toxicity. Which intervention should the nurse include in the client's plan of care. Select all that apply. A. Give olanzapine 10 mg IM q2h PRN to treat agitation B. Allow the client to sleep and eat as much as desired C. Administer labetalol 20 mg IV to control hallucinations D. Monitor 1:1 to protect client from harm to self and others E. Encourage involvement in the therapeutic treatment milieu

A. Give olanzapine 10 mg IM q2h PRN to treat agitation B. Allow the client to sleep and eat as much as desired D. Monitor 1:1 to protect client from harm to self and others Olanzapine: benzo. Allowing the client to sleep as much as they want is actually good because when they're on meth they don't sleep or eat. Why not C? It's a -lol med, and it doesn't help with hallucination, rather it's used to treat elevated BP. Why not E? No, you want to keep them away from others.

Which interventions are most appropriate for caring for a client in alcohol withdrawal? A. Monitor VS B. Maintain NPO status C. Provide a safe environment D. Address hallucinations therapeutically E. Provide stimulation in the environment F. Provide reality orientation as appropriate

A. Monitor VS C. Provide a safe environment D. Address hallucinations therapeutically F. Provide reality orientation as appropriate

The nurse is caring for the client who is 2 days post-admission to a medical unit and has a long hx of heavy alcohol abuse. The nurse should monitor for which acute complications related to alcohol abuse? Select all that apply. A. Seizures B. Pancreatitis C. GI bleeding D. Exophthalmos E. Delirium tremens

A. Seizures B. Pancreatitis C. GI bleeding E. Delirium tremens Key words are acute complications. Alcohol causes everything to get inflamed, and is actually is the main cause of pancreatitis.

The client is admitted to the hospital for alcohol detox. Which of the following interventions would the nurse use? Select all that apply. A. Taking vital signs B. Monitoring I/Os C. Placing the client in restraints as a safety measure D. Reinforcing reality if the client is disoriented or hallucinating E. Explaining to the client that the symptoms of withdrawal are temporary

A. Taking vital signs B. Monitoring I/Os D. Reinforcing reality if the client is disoriented or hallucinating E. Explaining to the client that the symptoms of withdrawal are temporary

The client diagnosed with delirium tremens when trying to quite "cold turkey", is admitted to the medical unit. Which medications would the nurse anticipate administering? A. Thiamine (vitamin B1) and Librium (a benzodiazepine) B. Dilantin (an anticonvulsant) and Feosol (an iron preparation) C. Methadone (a synthetic narcotic) and Depakote (a mood stabilizer) D. Mannitol (an osmotic diuretic) and Ritalin (a stimulant)

A. Thiamine (vitamin B1) and Librium (a benzodiazepine)

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." What is the most helpful response by the nurse? A. "Why don't you tell your spouse about this?" B. "What do you find difficult about this situation?" C. "This is not the best time to make that decision." D. "I agree with you. You should get out of this situation."

B. "What do you find difficult about this situation?"

The nurse is caring for a client who is experiencing cocaine intoxication. Which of the following would indicate that the client's condition is deteriorating? Select all that apply. A. Dyskinesias. B. Angina C. Decreased urinary output D. Hypertension E. Anxiety F. Tachycardia

B. Angina D. Hypertension F. Tachycardia Dyskinesias: uncontrolled movements. Not a sign of deterioration, just an effect from cocaine.

A male client is saying he is "wired", feels like he is on "pins and needles" and is irritable. He says he stopped using alcohol abruptly. What is the nurse's next interventions in caring for this client? A. Wait to see if any other symptoms occur in the next few hours and then report them to the physician B. Assess the time of his last drink and begin assessing signs and symptoms of alcohol withdrawal C. Assess the client for all current substance-use patterns, including time of last usage, and begin to assess for withdrawal D. Ask the physician to write an order for a stimulant medication to help prevent delirium tremens

B. Assess the time of his last drink and begin assessing signs and symptoms of alcohol withdrawal Why not C? You want to address the immediate, you're wasting time if you pick C. This is more emergent, he could go into DT.

The nurse documents which of the following clinical manifestations to be present in a client who is experiencing cannabis intoxication. Select all that apply. A. Anorexia B. Dry mouth C. Euphoria D. Bradycardia E. Sensation of slowed time F. Drowsiness

B. Dry mouth C. Euphoria E. Sensation of slowed time Why not A? THC tends to make people hungry. Why not D? They actually experiencing tachycardia. THC-affected people actually can be aware that time is slowed down, while people who are intoxicated by alcohol won't be aware that their reaction time is affected. Withdrawal sign from marijuana actually could be anxiety.

After completing a family session about addiction, a woman approaches the nurse and shares that as a mother, she will always have to bear the suffering of having a chemically dependent daughter who could relapse at any time. What would be one important information to share about family recovery from addiction? A. Family recovery can begin when the addictive behavior ceases B. Family recovery can begin even if active use continues C. Family recovery will fail if the recovering addict relapses D. Family recovery will be enhanced if the recovery addict attends several AA meetings

B. Family recovery can begin even if active use continues

A client who is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg and pulse is 92 bmp. Which of the following medications would the nurse expect to administer? A. Haloperidol (Haldol) B. Lorazepam (Ativan) C. Benztropine (Cogentin) D. Naloxone (Narcan)

B. Lorazepam (Ativan)

The client taking disulfiram has a throbbing headache, diaphoresis, and sudden vomiting. Which possible conclusion by the nurse should be explored first? A. The client may have developed influenza B. The client may have recently consumed alcohol C. The client may have recently take a cough suppressant D. The client may have eaten foods that interact with disulfiram

B. The client may have recently consumed alcohol

The client is to be discharged from the hospital after a safe, medically supervised withdrawal form alcohol. Which of the following outcomes indicate client readiness for an outpatient alcohol treatment program? Select all that apply. A. The client states the need to cut down on his alcohol intake. B. The client verbalizes the damaging effects of alcohol on his body C. The client plans to attend AA meetings D. The client takes naltrexone (ReVia) daily E. The client verbalizes he is indestructible.

B. The client verbalizes the damaging effects of alcohol on his body C. The client plans to attend AA meetings D. The client takes naltrexone (ReVia) daily Why not A? After going through withdrawal program, they should be abstinent, so they shouldn't even have a drop of alcohol at this point.

The nurse is educating the client on methadone prescribed for replacement therapy while in an outpatient treatment program for heroin addicts. The client asks how taking a pill is going to help the client stay substance-free. Which statement is the nurse's best reply? A. "The methadone will give you the same high, so you won't want to use heroine anymore." B. "The methadone will cause you to become very sick if you take heroin at the same time." C. "The methadone 'replaces' heroin in your body, so you will have fewer cravings for heroin." D. "The methadone causes sedation; you'll sleep better so you can participate in your treatment."

C. "The methadone 'replaces' heroin in your body, so you will have fewer cravings for heroin." Methadone is used as a substitute, and is a daily medication. Falling out of favor now (due to undesirable effects), and now suboxone is used instead.

Which nursing assessment findings are consistent with methamphetamine abuse? A. Hypotension and bradycardia B. Constricted pupils and fatigue C. Anorexia and recent wt loss D. Bruises and scrapes on extremities

C. Anorexia and recent wt loss They actually have HTN, dilated pupils. D is too general. Also you would see scratches more because they pick at their skin.

The nurse completed an admission interview and assessment of the client who is under the influence of cocaine. Which finding should the nurse attribute to the client being under the influence of cocaine? A. Decreased of blood pressure and HR B. Lack of attention to the interview process C. Hypersensitivity in response to personal questions D. Underreporting the amt of cocaine used on a regular basis

C. Hypersensitivity in response to personal questions They are currently intoxicated. D is not specific to being under the influence. Why C? They would be hyper-vigilant, and hyper-attentive. They wouldn't have lack of attention, they would be hyper-attentive to things you say. Like focusing on one wrong word you say. And may become paranoid. Who might not be paying attention? Someone using pot, alcohol, or heroine.

The client is hospitalized after sustaining a head injury and a fractured wrist from a fall. The client admits to drinking alcohol in moderation several times per week. Which assessment finding should the nurse associate with early alcohol withdrawal? A. Agitation B. Somnolence C. Slightly elevated BP D. Delirium tremens (DTs)

C. Slightly elevated BP Why not A? Agitation is not an early sign. Irritability is though. Agitation is more heightened. DT is later sign.

A physician just wrote an order for a client to take naltrexone (ReVia). What would be the greatest concern of the nurse while getting ready to administer this medication? A. The mediation blocks the euphoric feeling from narcotics and alcohol B. Whether the physician provided good medication teaching C. The medication can precipitate withdrawal if the client is not completely detoxified D. The client will not be able to experience pleasurable sensations

C. The medication can precipitate withdrawal if the client is not completely detoxified Titrate to respirations and don't need to give them more than what gets them to minimum respiration that is considered safe range.

The female client tells the nurse, "I usually have a few drinks after work, but I always limit it to three. I'm not risking becoming addicted, am I?" What is the nurse's best response? A. "There is no harm in social drinking as long as you know your limits and you are not driving while intoxicated." B. "As long as you don't have any social problems associated with you use of alcohol, you don't need to be concerned." C. "If you are concerned about the frequency and the number of drinks consumed, then you might be developing a dependency." D. "Three drinks a day or seven drinks in a week is high-risk drinking for women. You seem concerned that you might have an alcohol dependency."

D Why not C? Could say this, but you're not incorporating education for the patient though.

The client receiving treatment for substance dependence has not been attending group therapy. Which response by the nurse to confront this behavior is best? A. "Why don't you want to go to group therapy? Others are there waiting for you to attend." B. "Talking about personal issues with others can be difficult. Try talking to the therapist alone." C. "Therapy is important to your treatment. You need to attend therapy if you want to get better". D. "You say you want to get better, but you are not actively participating in your treatment plan."

D. "You say you want to get better, but you are not actively participating in your treatment plan." Why not A? Second part of this statement ruins it - it's not about what other people think, they should be going for themselves. You don't really want to ask "why" questions either. Why D? This answer addresses it so that what is important right now is addressed with the patient.

Which of the following should the nurse include when preparing to teach a nicotine-cessation program? A. That nicotine withdrawal clinical manifestations include hot flashes, decreased appetite and muscle cramps B. Nicotine withdrawal symptoms last less than 1 week C. The nurse's personal experience with nicotine withdrawal D. A decreased psychomotor performance, mental dullness and decreased judgment may be experienced by the client

D. A decreased psychomotor performance, mental dullness and decreased judgment may be experienced by the client Nicotine withdrawal (physically) is very short (3-7 days). Post-acute withdrawal is what is longer and what's difficult. However, this answer was not marked as correct possibly because they're combining both. Sharing personal experience is ok, but not the best answer.

The client is diagnosed with Wernicke-Korsakoff syndrome as a result of chronic alcoholism. For which symptoms would the nurse assess? A. Insomnia and anxiety. B. Visual or auditory hallucinations C. Extreme tremors and agitation. D. Ataxia and confabulation

D. Ataxia and confabulation

The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? A. Hypotension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, course hand tremors, lethargy D. Hypertension, changes in LOC, hallucinations

D. Hypertension, changes in LOC, hallucinations HTN & hallucinations are a giveaway.

A client is transitioning to a less intensive level of outpatient treatment for addiction. The client statement that most reflects risk for relapse is: A. Dreaming about gambling or engaging in compulsive sex B. Not feeling happy C. Feeling hungry or tired D. Keeping thoughts of using a secret.

D. Keeping thoughts of using a secret.

After administering Naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? A. Cerebral edema B. Renal failure C. Seizure activity D. Respiratory depression

D. Respiratory depression You are giving Narcan for respiratory depression, so you want to monitor the respiratory depression. The order would actually say you keep giving it if there's no improvement (would be more specific than this). Why no A? There's not really a measurable way to December 6, 2019 monitor this. Why not B? Doesn't happen. Why not C? Seizure wouldn't be affected by Narcan. Note: Tinah did ask us if we've ever seen an order for naloxone. And noted down as something to maybe look at in the future (next term?).

30. The nurse is preparing to administer thiamine (vitamin B1) to the client receiving treatment for alcohol dependence. Which statement best describes the rationale for the use of thiamine? A. Thiamine improves the absorption of other essential vitamins and folic acid B. Thiamine helps to reserve the malnutrition often associated with alcohol abuse C. Thiamine reduces the risk of seizures occurring during withdrawal from alcohol D. Thiamine prevents neuropathy and confusion associated with chronic alcohol use

D. Thiamine prevents neuropathy and confusion associated with chronic alcohol use Why not B? In a way it does, but this is not the answer here. Why D? Weirnecke- Korsikoff. It would prevent that. Why not C? It does stabilizes the brain a little bit so it reduces risk a little bit, but they don't primarily prevent seizures

The client is receiving clonidine to relieve selected symptoms of opioid withdrawal. Which assessment is most important for the nurse to complete before administering clonidine? A. Check for presence of dilated pupils B. Investigate recent nausea and vomiting C. Test for abnormally heightened reflexes D. Verify that the blood pressure is not low

D. Verify that the blood pressure is not low Clonidine: Antihypertensive, short-acting, and centrally acting (can calm people down - ADHD). Why are they getting this? They are hypertensive during opioid withdrawal. Why not A? You would expect dilated pupils in opioid withdrawal, so why would you check for this again. Why not B? Clonidine doesn't affect N/V.