mental health test 4 EAQs
A client with a history of chronic alcohol use is prescribed disulfiram to treat the addiction. Which information concerning the effect of this medication should the nurse provide the client? "Euphoria is commonly experienced during the course of medication." "You will be monitored for seizures while you are taking this medication." "Expect to experience moderate sedation during this medication therapy." "You can experience adverse effects if you consume alcohol while taking this medication."
"You can experience adverse effects if you consume alcohol while taking this medication." Disulfiram is used to treat substance abuse in clients. The client should be sure to avoid consuming alcohol during the course of medication. The drug reacts with alcohol to form a toxic reaction, resulting in gastrointestinal and respiratory disorders. Nausea, seizures, and sedation are not observed in the course of this medication. Nausea is observed when a client consumes alcohol during the course of drug therapy. Seizures and sedation are observed during the course of medications like chlordiazepoxide (Librium), phenobarbital (Phenobarbital), and diazepam (Valium).
Which situation is most likely to produce fear when encountered by any mentally healthy adult? A large spider crawls along the kitchen wall. An elevator stops between floors because of a power outage. A gunman begins firing an assault weapon in a crowded mall. A storm accompanied by heavy thunder and lightning lasts for over an hour.
A gunman begins firing an assault weapon in a crowded mall. Fear is a reaction to a specific danger, such as that presented by a gunman attacking at a mall. While all of the other situations may produce some level of anxiety or may produce fear in an adult who is not mentally healthy, a gunman in a crowded mall presents a scenario of imminent, specific danger. Spiders, stopped elevators, and thunderstorms may scare those who have specific phobias of these situations.
A client is experiencing a panic attack. Which nursing intervention will be most therapeutic? Encourage the client to take slow, deep breaths. Verbalize mild disapproval of the anxious behavior. Offer an explanation about why the symptoms are occurring. Ask the client what he or she means when he or she says "I am dying."
Encourage the client to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. Verbalizing disapproval, offering an explanation about the symptoms, and asking the client what he or she means will not be helpful to the client during a panic attack and may exacerbate it.
Which symptom is commonly associated with panic attacks? Fever Apathy Obsessions Fear of impending doom
Fear of impending doom
A client receives a new prescription for sertraline 50 mg daily. The client phones the nurse and says, "I read on the internet that this drug is for depression. I have social anxiety, not depression." Which response should the nurse provide? "The website was incorrect. Sertraline is an antianxiety medication rather than an antidepressant." "Thank you for informing us of this error. I will discuss the situation with your health care provider and call you back shortly." "Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." "It is important for you to take the medication. Try to have confidence in your health care provider's judgment about how to help you."
"Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." The nurse should explain to the client that selective serotonin reuptake inhibitors (SSRIs) are considered the first line of defense in most anxiety disorders, including social anxiety. Sertraline and paroxetine are SSRIs with calming effects. The website was not incorrect, and the prescription was not made in error. The nurse should provide a more complete response than telling the client to simply have confidence in the health care provider's judgment.
Which statement indicates the existence of a codependent relationship between a client diagnosed with substance abuse and their life partner? "All our savings have been spent on rehab treatment." "They are the love of my life but it's so hard living together." "I'm always so angry about how the addiction controls our lives." "Everyone knows about the addiction and it is so very embarrassing."
"I'm always so angry about how the addiction controls our lives." Codependent individuals find their moods being influenced by the situation and the emotions of the abuser. While the other options reflect common characteristics of a relation involving substance abuse, they do not necessarily demonstrate a codependency.
Which response is appropriate when teaching a client regarding a prescription for naltrexone? "It helps your mood so that you don't feel the need to do drugs." "It will keep you from experiencing flashbacks." "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions." "It helps prevent relapse by reducing your drug cravings."
"It helps prevent relapse by reducing your drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. Improving mood, preventing flashbacks, and helping one to sleep do not accurately describe the action of naltrexone.
Buspirone is prescribed for a client diagnosed with anxiety. Which instruction should the nurse provide to this client? "Take this medication on an empty stomach." "Take this medication only when you feel anxious." "It will take 3 or more weeks for you to feel the full benefit." "Avoid consuming aged cheese products while you are taking this medication."
"It will take 3 or more weeks for you to feel the full benefit." Buspirone is an alternative antianxiety medication that does not cause dependence, but 3 or more weeks are required for it to reach full effects. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking MAOIs (monoamine oxidase inhibitors).
A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "Everyone else gets away with it all the time. You're trying to cause me to fail." Which is the instructor's most appropriate response? "Other students get caught as well." "I am not trying to cause you to fail. I am here to help you." "I am sorry you feel that way. I try to treat all my students equally." "The requirements for this experience were discussed during our orientation."
"The requirements for this experience were discussed during our orientation." The student is demonstrating projection, as evidenced by not taking responsibility for his or her own behavior and blaming the instructor for a perception of failing. Reminding the student that the rules were presented during orientation allows the instructor to avoid a defensive response and reinforce that responsibility belongs to the student. Denying that other students are allowed to dress improperly, dismissing the student's claim, and stating that the instructor treats all students equally are responses that do not address the student's responsibility for meeting the requirements.
In a clinical interview, a client says, "My mother and I are afraid of darkness, so we always carry a flashlight with us." Which theory is evident in this case? Cognitive theory Behavioral theory Interpersonal theory Psychodynamic theory
Behavioral theory According to behavioral theory, the client shows a learned response to specific environmental stimuli. The client has observed his or her mother's fear of darkness and also developed a fear of darkness. According to cognitive theory, the client has poor perception of situations and tends to develop a panic attack by thinking about the situation. According to interpersonal theory, the client develops emotional distress transmitted from mother or caregivers. According to psychodynamic theory, anxiety disorder is developed in a person during childhood due to unconscious conflicts in his or her surroundings.
Which behavior would be characteristic of an individual who is displaying passive aggression? Lying Stealing Slapping Procrastinating
Procrastinating Rationale A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance. Lying, stealing, and slapping are direct aggressions.
The nurse is helping a client through deep breathing exercises when the client is experiencing severe anxiety. Which sign after performing this exercise would indicate that the client's anxiety has decreased? The client is quiet, yet confused. The client stops running and shouting. The client demonstrates selective inattention. The client demonstrates absence of false sensory perception.
The client demonstrates selective inattention. In the client with severe anxiety, learning may be impaired because of inattention. The individual can focus on only one particular detail and has difficulty noticing what is going on in the environment, even if another person points it out. A client with moderate anxiety demonstrates selective inattention, wherein the client can perceive stimuli in the environment when it is pointed out. Therefore, for a client with severe anxiety, selective inattention indicates improvement. Being confused is an indicator of severe anxiety. Pacing, running, shouting, and false sensory perceptions would not be seen in a client with severe anxiety; these are manifestations of panic attack.
A 72-year-old client is diagnosed with Parkinson's disease and anxiety. The health care provider prescribes a benzodiazepine. The nurse knows to double-check this prescription based on what fact related to this classification of medications? This medication would increase the client's risk for falls. Older adults become addicted faster than younger clients. Cognitive therapies are more effective than medications for the older adult. Benzodiazepines have serious side effects, so clients are often noncompliant.
This medication would increase the client's risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In older adults who may have a higher risk of falls, a benzodiazepine may be contraindicated. There is no evidence to suggest that older adults become addicted faster than younger clients. Medication and other therapies are used congruently with all age levels. This classification of medications generally is not associated with nonadherence.
What is the most likely nursing assessment finding when providing care for an alcohol-dependent client experiencing uncomplicated moderate alcohol withdrawal? Tremors Seizures Blackouts Hallucinations
Tremors Tremors are a sign of mild to moderate alcohol withdrawal. Seizures may be associated with alcohol overdose or withdrawal from heavy use. Blackouts may occur during substance use events. Hallucinations may occur from moderate to severe alcohol withdrawal.
A female client diagnosed with panic disorder is prescribed chlordiazepoxide. What is the most appropriate suggestion by the nurse? Use contraceptive methods. Stop the medication if there is insomnia. Stop the medication after 3 months. Coffee and tea are safe to drink and won't interact with the medication.
Use contraceptive methods. Chlordiazepoxide belongs to the benzodiazepine class of antianxiety drugs. It causes congenital anomalies in the fetus; therefore, the client should avoid becoming pregnant. Abruptly stopping the medication can cause withdrawal symptoms like dry mouth, tremors, and convulsions. The nurse should suggest discontinuing the medication after 3 to 4 months. Because caffeine decreases the efficacy of the benzodiazepines, the nurse should suggest the client avoid drinking coffee and tea.
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what drug? Cathinone γ-hydroxybutyrate (GHB) Salvia Clonidine
γ-hydroxybutyrate (GHB) The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies") and GHB and its congeners. These drugs are odorless, tasteless, and colorless, mix easily with drinks, and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. Cathinone is an amphetamine-like stimulant. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Clonidine is a centrally acting alpha-agonist hypotensive agent.
Which nursing intervention is most helpful to support improvement in an anxious individual's sense of control and competence? Provide large amounts of praise when the individual accomplishes assigned tasks. Educate the individual regarding the usefulness of stress management techniques. Help the individual identify several stress situations that he or she successfully managed. Have the individual describe how to demonstrate control and competence over stress.
Help the individual identify several stress situations that he or she successfully managed. Positive self-concepts result from positive experiences, leading to perceived competence and acceptance. Assisting the client in identifying such situations that he or she successfully managed will aid in building confidence. Being praised for successes is appropriate, but praise should be reserved for situations that the individual recognizes as meaningful. Although stress management techniques are important, they are not linked directly to a sense of competence. Describing how one demonstrates control and competence is applicable but has limited favor in actually assisting the client to feel competent.
Which symptoms are associated with opioid withdrawal? Lacrimation, rhinorrhea, dilated pupils, and muscle aches Illusions, disorientation, tachycardia, and tremors Fatigue, lethargy, sleepiness, and convulsions Synesthesia, depersonalization, and hallucinations
Lacrimation, rhinorrhea, dilated pupils, and muscle aches Symptoms of opioid withdrawal resemble the "flu"; they include lacrimation, rhinorrhea, dilated pupils, and muscle aches, as well as diaphoresis, cramps, chills, and fever. The characteristic symptoms of opioid withdrawal are not described accurately by illusions, disorientation, tachycardia, tremors, fatigue, lethargy, sleepiness, convulsions, synesthesia, depersonalization, and hallucinations.
Selective inattention is first noted when an individual Mild Moderate Severe Panic
Moderate Selective inattention is noted in moderate anxiety. The individual's perceptual field is reduced and the he or she is not able to see the entire picture of events. Selective inattention is not a feature of mild, severe, or panic level anxiety.
Inability to leave one's home in order to avoid severe anxiety suggests which anxiety disorder? Panic attacks with agoraphobia Obsessive-compulsive disorder Posttraumatic stress response Generalized anxiety disorder
Panic attacks with agoraphobia Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. Symptoms of obsessive-compulsive disorder include intrusive thoughts and/or ritualistic behaviors. Posttraumatic stress response occurs after an individual experiences or witnesses severe trauma. Generalized anxiety disorder is a chronic disorder marked by excessive and constant worrying.
What is the most important question to ask during assessment of a client diagnosed with an anxiety disorder? "How often do you hear voices?" "Have you ever considered suicide?" "How long has your memory been poor?" "Do your thoughts always seem jumbled?"
"Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is important for any client with an anxiety disorder. Hearing voices, poor memory and jumbled thoughts may be related to anxiety but are not as important to the client's safety as risk for suicide.
Which statement made by a client receiving treatment for a substance abuse problem best indicates an understanding of relapse prevention? "I want so much to stop abusing." "My family has helped me so much in staying sober." "I abuse when I'm bored or lonely, but now I know how to keep busy." "A good time always meant being with friends who abused like I did."
"I abuse when I'm bored or lonely, but now I know how to keep busy." The goal of relapse prevention is to help individuals identify their "trigger situations" so that periods of sobriety can be lengthened over time and lapses and relapses are not viewed as total failures. Identifying both the trigger and a plausible strategy makes that option the best one. The remaining options are more associated with the client's feelings about the addiction.
The nurse is assessing a child in a foster care home. The child's biological parents recently died in an accident. The foster parent tells the nurse that the child expresses feelings by making sketches. Which action should the nurse suggest? "You discipline punish the child for doing this." "The child is showing constructive behavior." "The child needs to have psychological counseling." "You should ask the child to become involved in other activities."
"The child is showing constructive behavior." The child makes sketches to project the repressed feelings associated with the death of the parents; this is an example of sublimation. The use of sublimation is constructive and should be encouraged. The nurse should not ask the caregiver to punish the child. The child is projecting feelings in a constructive and socially acceptable manner and does not require psychological counseling at this time or the need for other activities.
In confidence, an emergency department nurse says to a nursing colleague, "I know I am addicted to narcotics but I'm afraid I will lose my nursing license if I talk to my supervisor about it." Which is the colleague's most helpful response? "For the safety of your clients, you cannot use narcotics anymore. I hope you will get help." "I'm glad you were willing to tell me about this problem. I'll do what I can to help you." "There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." "There are many careers where you can use your nursing knowledge but not actually practice nursing. I will be glad to help you find one."
"There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." The colleague should first provide information about programming to give hope to the addicted nurse and encourage the nurse to talk to his or her supervisor. After responding, the colleague has a legal responsibility to report this information. The colleague should offer more assistance to the nurse than hoping that he or she will get help or being glad that the nurse shared the problem. Diversion legislation allows addicted nurses to attend a treatment or recovery program, have their progress monitored, meet specific criteria to return to work, and be spared revocation or suspension of their licenses if they follow the recommendations of their program.
What statement describes the appropriate method for dealing with transference or countertransference when managing care for clients diagnosed with substance use disorders? A nurse remains objective throughout the process. A different nurse will take over the responsibility of client care in each session. Evaluation of the client may not need to be ongoing. A residential care facility is needed for monitoring.
A nurse remains objective throughout the process. The nurse remains cautious about personal thoughts, opinions, and feelings, and remains objective throughout the process. A therapeutic relationship should be established between the nurse and the client. There is no need of introducing a new nurse in each session. An ongoing evaluation of the process must be conducted to eliminate transference or countertransference. This is done to maintain the objectivity of the treatment process and teach the client new skills to acquire a healthy lifestyle post recovery. A residential care facility is needed depending on the client's health-related issues. This has no effect on nurse and client relationship.
What is an appropriate long-term goal or outcome for a client recovering from substance abuse? Discuss the addiction with significant others State an intention to stop using illegal substances Abstain from the use of mood-altering substances Substitute a less-addicting drug for the present drug
Abstain from the use of mood-altering substances Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. Discussing the addiction with significant others and stating an intention to stop using illegal substances should occur earlier in the treatment process. Substituting a less-addicting drug is inadvisable.
A client just learned that a family member was diagnosed with a serious illness. At this time, the client is pacing, distracted, breathing rapidly, complaining of nausea, and having trouble focusing on anything other than the family member's illness. Which initial nursing comment is most therapeutic? "You seem anxious. Would you like to talk about how you are feeling?" Address the client by name and say, "You are safe. First, take a deep breath." "You cannot help the other members of your family if you do not calm down." "There are always specialists who can help. Try not to worry about your loved one."
Address the client by name and say, "You are safe. First, take a deep breath." This client is experiencing severe anxiety, so the perceptual field is reduced greatly. The person may be dazed and confused. Behavior is automatic and usually includes somatic symptoms (e.g., headache, nausea, dizziness, insomnia, trembling, hyperventilation, palpitations). Appropriate nursing interventions are to provide for safety and offer firm, short, and simple statements. When the person's anxiety level lowers, feelings can be explored. Pressure to calm down and false reassurance are not therapeutic and will be ineffective during this level of anxiety.
A client is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior? Thalamus Amygdala Hypothalamus Pituitary gland
Amygdala The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones.
Which scenario presents the most accurate example of altruism? After recovering from a gunshot wound, a police officer attends a local support group. After recovering from open-heart surgery, an individual plays tennis three times a week. An individual with a longstanding fear of animals volunteers at a community animal shelter. An individual who received a liver transplant volunteers at a local organ procurement agency.
An individual who received a liver transplant volunteers at a local organ procurement agency. Altruism is a healthy defense mechanism in which emotional conflicts and stressors are addressed by meeting the needs of others. With altruism, the person receives gratification either vicariously or from the response of others. Volunteering at a local organ procurement agency after receiving an organ transplant meets the needs of others. Attending a support group, playing tennis, and volunteering at an animal shelter to address one's own fears are all examples of meeting the individual's needs, but they are not necessarily altruistic.
The administration of a member of what medication classification is the nurse's priority intervention when caring for a client experiencing severe alcohol withdrawal symptoms? Appetite stimulants Hypnotics Antipyretics Anticonvulsants
Anticonvulsants The client experiencing severe symptoms of alcohol withdrawal may experience generalized seizures, which are managed by administration of prescribed anticonvulsant medication. This treatment is the most important nursing intervention in clients with severe alcohol withdrawal symptoms. Prescribed hypnotic medications are administered to treat insomnia, which is a mild symptom of alcohol withdrawal. Anorexia is also a mild symptom of alcohol withdrawal and can be managed with suitable appetite stimulants. Clients with severe alcohol withdrawal symptoms may experience a high-grade fever. The nurse should administer the prescribed antipyretic to reduce the fever; however, it is not the most important intervention.
The nurse suspects a client of substance abuse. What should be the nurse's priority intervention? Assessment for substance use and comorbidities Referral to detoxification program Magnetic resonance imaging study of brain Positron emission tomography of brain
Assessment for substance use and comorbidities An accurate assessment for substance use and other mental health disorders is key to successful treatment planning. The nurse needs to determine what substance or substances the client is using, as well as underlying medical and mental health disorders that may impact treatment. A referral is done after the assessment and counseling. Magnetic resonance imaging and positron emission tomography help in understanding the underlying neurobiology of the brain but are not the priority.
Which assessment data would be most consistent with a severe opiate overdose? Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min
Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min The data consistent with opiate overdose are blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min. Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.
As the nurse teaches a preoperative client, the client becomes more and more anxious as the information is presented. Soon the client begins to report dizziness and heart pounding. The nurse observes obvious trembling and confusion. Which is the nurse's priority intervention? Reinforce the preoperative teaching by restating it slowly. Have the client read the teaching materials instead of listening to them. Have a familiar family member read the preoperative materials to the client. Cease any further attempt at preoperative teaching at this time and instead encourage deep breathing.
Cease any further attempt at preoperative teaching at this time and instead encourage deep breathing. Clients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems, so the nurse should cease preoperative teaching and encourage deep breathing exercises to help the client calm down. Restating the preoperative teaching slowly, having the client read the teaching materials instead of listening to them, and having a familiar family member read the preoperative materials to the client would not be effective because a person is unable to learn effectively while experiencing severe anxiety.
Which statement is true regarding obsessive-compulsive disorder (OCD)? Behaviors suggestive of OCD usually begin in infancy. Hospitalization is often necessary for persons diagnosed with OCD. Clients diagnosed with OCD should be assessed regularly for risk for suicide. Compulsions are repetitive thoughts, whereas obsessions are ritualistic behaviors.
Clients diagnosed with OCD should be assessed regularly for risk for suicide. People suffering from OCD may become desperate and attempt suicide. Risk for suicide should be assessed regularly in these clients. Obsessive-compulsive disorder can begin in childhood, with symptoms present as early as age 3, but symptoms would not be expected in infancy. People with obsessive-compulsive disorders rarely need hospitalization unless they are suicidal or have compulsions that cause injury. Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety. Obsessions are thoughts, impulses, or images that persist, recur, and cannot be dismissed from the mind.
A child is extremely upset because of being constantly bullied by peers for having a short stature. While educating the child, the nurse states, "Your stature is not going to affect your fitness. You could always excel in other aspects like sports and academics." Which defense mechanism is the nurse encouraging in the child? Displacement Compensation Identification Dissociation
Compensation The nurse's statement indicates that the nurse is trying to counterbalance the perceived deficiencies in the child and advise the child to focus on other activities. The nurse is encouraging the positive use of compensation as a defense mechanism. Displacement is a defense mechanism wherein an individual transfers the emotions related to a particular person or situation to a nonthreatening person or object. Identification is a defense mechanism wherein an individual tries to imitate the characteristics of another person or group. Dissociation is a defense mechanism wherein an individual mentally separates himself or herself from unpleasant situations.
A client hospitalized 3 days ago with vomiting and tachycardia, is now both irritable, restless and diaphoric. What is the nurse's best action?</p> Conduct a thorough search in the client's room for hidden opioid medications. Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Assess for a delayed reaction to a blood transfusion. Adjust the temperature in the client's room to facilitate client comfort.
Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Vomiting and tachycardia are medical complications of withdrawal from chronic alcohol abuse; the admitting diagnosis is a clue to be observant for alcohol-related problems. Diaphoresis (sweating) and fever are associated with alcohol withdrawal. Irritability and restlessness are additional clues to alcohol withdrawal. These symptoms are not associated with opioid abuse. Reactions to blood transfusions occur immediately. The client's sweating is likely a result of alcohol withdrawal and not excessively high room temperature.
Which statement is true regarding substance addiction and medical comorbidity? Medical comorbidities are uncommon among clients with substance abuse disorders. Little research has been done regarding substance abuse disorders and medical comorbidity. Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Comorbid conditions are thought to positively affect those with substance abuse disorders because clients seek help for symptoms sooner.
Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Medical comorbidities are common. There is research, such as the 2001-2003 National Comorbidity Survey Replication (NCS-R), showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction by causing added symptoms, stress, and burden.
The nurse is planning care for a client diagnosed with alcohol abuse. What intervention does the nurse plan for rehabilitation of this client? Develop motivation and self-help skills. Avoid repeated counseling. Refrain from assessing alcohol consumption. Avoid discussing the effects of alcohol intake.
Develop motivation and self-help skills. The client needs assistance with motivation, support, and self-help skills to instill hope and positivity. Repeated counseling, follow-ups, or specialty referrals should be planned as required. Alcohol consumption should be assessed using a brief screening tool. The client should be clearly advised about the effects of alcohol consumption.
A woman feels a lump in her breast. She anxiously says to her spouse, "I have cancer. It probably has spread all over my body." Which nursing diagnosis and etiology best apply to this situation? Ineffective coping related to panic level anxiety Disturbed body image related to malignant breast cancer Self-esteem disturbance related to outcome of breast self-exam Fear related to misinterpretation and misinformation about breast self-exams
Fear related to misinterpretation and misinformation about breast self-exams Fear is a response to a perceived threat or danger that may inhibit problem-solving and lead to apprehension about the future. The person is ill-informed about the findings and misinterprets the potential prognosis. Although the body image may be disturbed, it is not related to malignant cancer. There is no evidence of self-esteem disturbance.
Which observation indicates to the nurse that a client is at risk for codependent behavior? Promising to change his or her irresponsible behavior Lack of empathy and care toward others Family history of tobacco abuse Feeling guilt for a family member's drug use
Feeling guilt for a family member's drug use Codependence involves overresponsible behavior and performing activities for others that they could perform on their own. Codependence is common among friends and family members of individuals with substance-related and addictive disorders. Feeling guilt for someone else's drug us is an example of a codependent behavior. Promising to change one's own behavior, lack of empathy, and family history of tobacco use are not risk factors for codependent behaviors.
Cocaine exerts which of the following effects on a client? Drowsiness Increased metabolism Immediate imbalance of emotions Paranoia
Increased metabolism Cocaine exerts a stimulant effect on metabolism and may cause extreme weight loss. Cocaine does not cause drowsiness. Imbalanced emotions and paranoia may occur during cocaine withdrawal.
How does the counselor integrate motivational interviewing as a tool in the treatment plan of a client with a substance use disorder? It helps the counselor use strategies to resolve ambivalence and evoke internally motivated change. It introduces an alternative treatment process that is parallel to the current treatment process. It modifies the current treatment process by evaluating it frequently and giving inputs related to health care. It assesses the substance-related disorder and determines if other comorbidities are present.
It helps the counselor use strategies to resolve ambivalence and evoke internally motivated change. A counselor first understands the change that is occurring in the individual as it relates to the client's substance use disorder. Then, the counselor assists the client in correlating the change in the individual with the treatment process. A counselor works as a part of the treatment process rather than introducing an alternative plan. A counselor assists the client to develop coping skills and motivates the client to follow the treatment plan. The evaluation of the treatment plan is not a part of counseling. The assessment of substance use disorder and comorbidities is done after the screening and counseling is based on that assessment. p. 316
Which therapeutic intervention can the nurse implement independently to help a client experiencing mild anxiety regain control? Modeling Thought stopping Response prevention Systematic desensitization
Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently by the nurse. Thought stopping, response prevention, and systematic desensitization require agreement of the treatment team.
What characteristic should the nurse monitor to best ensure the safety of a client who has a blood alcohol level of 0.08 mg %? Confusion Motor coordination Fever Respiration
Motor coordination The client with a blood alcohol level of 0.08 mg % will have decreased motor coordination. When the blood alcohol level is at 0.30 mg %, the person will have a high level of confusion. Fever may occur during alcohol withdrawal. Respiration may be impaired when blood alcohol level is 0.50 mg %.
A client diagnosed with panic disorder begins a new prescription for lorazepam. The nurse should provide instructions to discontinue which of this client's usual routine activities? Sewing Mowing the lawn Playing video games Preparing dinner for the family
Mowing the lawn Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the client to sew, play video games, and prepare meals.
A client with a history of cocaine abuse is brought to the hospital in an unconscious state. Which nursing intervention will the nurse implement? Induction of vomiting Administration of ammonium chloride Monitoring of opiate withdrawal symptoms Observation for cardiac dysfunction
Observation for cardiac dysfunction Rationale The nurse should observe the client for cardiac dysfunction, which may be observed in clients experiencing central nervous system stimulant overdose. The nurse should not induce vomiting while the client is unconscious. Ammonium chloride is a treatment for amphetamine overdose. Cocaine is not an opiate, so opiate withdrawal symptoms are not relevant to this client. p. 298
A client with a history of cocaine abuse is brought to the hospital in an unconscious state. Which nursing intervention will the nurse implement? Induction of vomiting Administration of ammonium chloride Monitoring of opiate withdrawal symptoms Observation for cardiac dysfunction
Observation for cardiac dysfunction The nurse should observe the client for cardiac dysfunction, which may be observed in clients experiencing central nervous system stimulant overdose. The nurse should not induce vomiting while the client is unconscious. Ammonium chloride is a treatment for amphetamine overdose. Cocaine is not an opiate, so opiate withdrawal symptoms are not relevant to this client.
The nurse, assessing a client reporting fever, diarrhea, and nausea, notes the dilation of the pupils and heightened reflexes. These assessment finding support which medical diagnosis? Opioid withdrawal Opioid intoxication Alcohol withdrawal Stimulant withdrawal
Opioid withdrawal Opioid withdrawal manifests as a set of physiological symptoms that begin to occur when the concentration of opium decreases in the client's bloodstream. Symptoms include fever, diarrhea, and nausea. These symptoms are not caused by opioid intoxication, alcohol withdrawal, or stimulant withdrawal. Opioid intoxication is characterized by decreased heart rate, blood pressure, body temperature, body reflexes, and pinpoint pupils. Alcohol withdrawal is characterized by restlessness, irritability, impairment in functioning, and trembling. Stimulant withdrawal is characterized by depression, poor concentration, and paranoia.
A client with a history of drug abuse reports experiencing insomnia. Upon assessment the nurse finds that the client has enlarged pupils associated with continuous tearing of the eyes. In the report, the nurse documents that the client was showing signs of which related condition? Opioid withdrawal Opioid intoxication Stimulant withdrawal Stimulant intoxication
Opioid withdrawal Screening or diagnosis of substance use disorders includes identification of related symptoms. Symptoms of opioid withdrawal are characterized by difficulty in regular sleep pattern (insomnia), enlarged pupils (mydriasis), and continuous tearing of eyes. These symptoms do not indicate opioid intoxication, stimulant withdrawal, or stimulant intoxication. Opioid intoxication is characterized by bradycardia, feelings of sedation, and pinpoint pupils (meiosis). Stimulant withdrawal is characterized by symptoms ranging from decreased energy and dilated pupils to depression, chest pain, and irregular breathing pattern. Stimulant intoxication is characterized by fatigue, anxiety, and irritability.
A client is running from chair to chair in the solarium. The client is wide-eyed and keeps repeating, "They are coming! They are coming!" The client neither follows staff direction nor responds to verbal efforts to calm him or her. The nurse assesses the client's anxiety at which level? Mild Moderate Severe Panic
Panic Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety. Mild, moderate, and severe levels of anxiety typically do not include such extreme behavior.
The plan of care for a client who uses elaborate washing rituals specifies that response prevention is to be applied. Which scenario is an example of response prevention? Withholding reassurance from staff Having the client repeatedly touch dirty objects Telling the client to relax whenever tension mounts Preventing the client from washing hands after touching a dirty object
Preventing the client from washing hands after touching a dirty object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without health care provider approval. Not allowing the client to wash hands after touching a perceived "dirty" object is an example of response prevention. Not allowing reassurance, repeatedly touching "dirty" objects, , and telling the client to relax are not examples of response prevention.
An adult client is currently experiencing amphetamine withdrawal. Which assessment finding is a common characteristic of this process? Dilated pupils Irregular heart rate Excessive motor activity Psychomotor retardation
Psychomotor retardation Withdrawal from amphetamines is commonly associated with symptoms of depression. Psychomotor retardation commonly accompanies depression. Dilated pupils, dry oronasal cavity, irregular heart rate, and excessive motor activity are symptoms of amphetamine intoxication.
Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike the following week. The client replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident in the adult's response? Displacement Rationalization Passive aggression Reaction formation
Rationalization The correct answer, rationalization, refers to justifying an action to satisfy the teller and the listener, which the client does by using hiking shoes as an excuse to mask the real reason for not going. Displacement is the transfer of emotions about a particular person, object, or situation to one that is nonthreatening. Passive aggression is the indirect and unassertive expression of aggression toward others. Reaction formation involves keeping unacceptable feelings or behaviors out of one's awareness by developing the opposite behavior or emotion.
A primary health care provider instructs a nurse to document cognitive-behavioral therapy as part of the care plan for a client with social phobia. What intervention does the nurse know is appropriate for the client during the cognitive-behavior therapy? Support the client's beliefs. Re-evaluate the client's situation. Give an opinion on client's thoughts. Calm the client through isolation from peers.
Re-evaluate the client's situation. Cognitive behavioral therapy helps clients learn to control negative feelings. The nurse should re-evaluate the situation realistically and develop a positive insight in the client by replacing the negative thoughts. The nurse should not support the client's negative beliefs. The nurse should not give his or her own opinion on the client's thoughts, because doing so may make the client feel rejected. The nurse should not isolate the client from peers, because doing so could cause withdrawal and aggression in the client.
Which type of facility would most support the needs of an impaired client who requires long-term help related to hallucinogen abuse? Halfway house Partial hospitalization Intensive outpatient program Residential rehabilitation center
Residential rehabilitation center A client with severe impairment due to hallucinogen abuse can receive long-term professional medical care in a residential rehabilitation center. Residents of halfway houses reside at the house, but continue working outside. These clients may be more vulnerable to relapse. Partial hospitalization provides a combination of psychotherapy and educational groups without having to reside at the hospital, but is not the best support for the client who is severely impaired. An intensive outpatient program is nonresidential and only provides medication oversight; this would not be the best choice for a severely impaired client.
An adult invites 14 guests for Thanksgiving dinner. Just before the guests arrive, the adult notices the turkey is burned and inedible. Which behavior by this adult indicates adaptive coping? Going to bed and leaving the guests unattended. Calling all the guests and canceling the invitation for dinner. Saying to the guests, "We are having a vegetarian Thanksgiving dinner this year." Telling the guests, "My oven malfunctioned. You will have to eat burned turkey."
Saying to the guests, "We are having a vegetarian Thanksgiving dinner this year." In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Leaving guests unattended and canceling the dinner are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement. p. 133
An outpatient psychiatric nurse assesses a client diagnosed with hoarding disorder. The client has lost 12 lb in the past two months and is wearing dirty, disheveled clothing. What is the nurse's priority action? Review the client's medication regime. Ask the client, "What types of foods have you been eating?" Refer the client to a psychologist for cognitive behavioral therapy (CBT). Schedule a home visit to assess the safety of the client's living conditions.
Schedule a home visit to assess the safety of the client's living conditions. Safety is the nurse's first priority in the case of a client with hoarding disorder. Individuals diagnosed with hoarding disorder often live in unsafe conditions. A home visit will help identify whether safety is the primary concern. Reviewing the client's medications and diet, and referring the client for CBT are proper steps to take, but only after the client's safety has been established.
A client frantically reports to the nurse, "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." At what level should the nurse assess the client's anxiety? <p>A client frantically reports to the nurse, "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." At what level should the nurse assess the client’s anxiety?</p> Mild Moderate Severe Panic
Severe Rationale Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild to moderate anxiety would not involve a pounding heart and throbbing head. Panic-level anxiety would render a client unable to ask the nurse for help.
The nurse caring for a client experiencing a panic attack expects the health care provider to prescribe an immediate dose of which type of medication? Anticholinergic medication Standard antipsychotic medication Tricyclic antidepressant medication Short-acting benzodiazepine medication
Short-acting benzodiazepine medication A short-acting benzodiazepine is the only type of medication listed that would lessen the patient's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety. Standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects. Tricyclic antidepressants have very little antianxiety effect and have a slow onset of action.
What is the most likely potential problem for a client diagnosed with severe obsessive-compulsive disorder? Sleep disturbance Excessive socialization Command hallucinations Altered state of consciousness
Sleep disturbance Clients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. Excessive socialization, command hallucinations, and altered states of consciousness are not typically associated with obsessive-compulsive disorder.
A client attempted suicide 3 days ago. When the nurse asks about the related events, the client says, "I don't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the client used? Repression Suppression Rationalization Intellectualization
Suppression Defenses against anxiety can be adaptive or maladaptive. Suppression is a conscious, deliberate effort to avoid painful and anxiety-producing memories. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. In this scenario, the client is aware of the memory. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. Intellectualization is a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion.
When a client is prescribed lorazepam 1 mg orally four times a day for 1 week for generalized anxiety disorder, what should the nurse do? Question the health care provider's prescription regarding the high dose. Explain the long-term nature of benzodiazepine therapy to the client. Teach the client to limit caffeine intake. Tell the client to expect mild insomnia.
Teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. The nurse should instruct the client to limit caffeine intake. The dose is not excessive. Benzodiazepines are typically taken short-term. Mild insomnia is not a typical side effect of lorazepam.
When considering substance abuse, which individual is at the greatest risk for developing functional deficits in the future? The 15-year-old abusing cannabis The 28-year-old with a cocaine habit The 45-year-old with a 10-year history of heroin abuse The 60-year-old who has been dependent on sedatives for 15 years
The 15-year-old abusing cannabis The 15-year-old abusing cannabis is at greatest risk for developing functional deficits. The brain doesn't fully mature until the mid-20s; therefore, substances of abuse can interfere with brain ability to function in the future. Ingestion of drugs during youth and teenage years can also interfere with psychological and social growth, decrease the potential for a productive future, and it terminates the life span of too many children and teenagers. Although cocaine, heroin, and sedative users may experience adverse effects, they are at less of a risk of developing functional deficits because they are older.
A client was in an automobile accident, and although there is the odor of alcohol on the client's breath, the client's speech is clear, and the client is alert and can answer questions. The client's blood alcohol level is determined to be 0.30 mg %. What conclusion can be drawn? The client has a high tolerance to alcohol. The client ate a high-fat meal before drinking. The client has a decreased tolerance to alcohol. The client's blood alcohol level is within legal limits.
The client has a high tolerance to alcohol. The client has a high tolerance to alcohol. A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. This scenario is not suggestive of the client eating a high-fat meal or having decreased tolerance to alcohol. The blood alcohol level is well above the legal limit in most states.
In a teaching session, the nurse uses strategies that will induce a slight degree of anxiety for the clients attending the session. What is the nurse's intention for this action? The clients will be more focused during the session. The clients will be more expressive during the session. The clients will be more comfortable during the session. The clients will be more willing to participate in the session.
The clients will be more focused during the session. Mild anxiety causes clients to see, listen, and grasp more information. This helps the clients to focus more on whatever is taught during the teaching session. Mild anxiety is unlikely to improve the clients' expression, comfort level, or willingness to participate.
A client diagnosed with obsessive-compulsive disorder takes several hours to maintain hygiene. What appropriate method does the nurse apply to help the client in maintaining hygiene? The nurse gives a wide variety of clothing options to the client. The nurse gives continuous directions to the client. The nurse discusses with the client his or her feelings about self-care. The nurse dresses the client.
The nurse discusses with the client his or her feelings about self-care. Clients diagnosed with obsessive-compulsive disorder spend several hours maintaining hygiene. The nurse should talk with the client regarding self-care and encourage the client to express his or her feelings and thoughts about self-care to help reduce the compulsive behavior. Limiting the choice of clothing helps the client to select clothes quickly. The nurse gives simple directions to the client to enhance self-hygiene. The nurse should not dress the client but can assist the client in dressing. The nurse should encourage the client to perform the task independently.
A 72-year-old client is diagnosed with Parkinson's disease and anxiety. The health care provider prescribes a benzodiazepine. The nurse knows to double-check this prescription based on what fact related to this classification of medications? This medication would increase the client's risk for falls. Older adults become addicted faster than younger clients. Cognitive therapies are more effective than medications for the older adult. Benzodiazepines have serious side effects, so clients are often noncompliant.
This medication would increase the client's risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In older adults who may have a higher risk of falls, a benzodiazepine may be contraindicated. There is no evidence to suggest that older adults become addicted faster than younger clients. Medication and other therapies are used congruently with all age levels. This classification of medications generally is not associated with nonadherence.
What is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder? <p>What is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder?</p> To protect the nurse legally To establish the nursing diagnoses of priority To obtain information about the client's psychosocial background To determine whether the anxiety is primary or secondary in origin
To determine whether the anxiety is primary or secondary in origin Rationale The symptoms of anxiety can be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause. The physical examination does not serve to protect the nurse legally. The physical examination may inform the nursing diagnoses but this is not its primary purpose. Information about the client's psychosocial background can be obtained by interviewing the client, not through a physical examination.
The nurse is working with a support team that manages the care of clients diagnosed with substance use disorders. Why would the nurse consider providing encouragement for self-care as an important step? To explore harmful thoughts To test newly acquired coping skills in a safe setting To see beyond the current situation To improve self-esteem of the clients
To improve self-esteem of the clients Providing support and encouragement helps to improve self-esteem of the clients, because most may have neglected themselves. To explore harmful thoughts, developing a therapeutic relationship can help. Current coping skills should be understood and new skills should be identified by the client to help test the skills in safe settings. To see beyond the current situation and become hopeful, the client should be assisted in goal-setting.
A client diagnosed with severe addiction to alcohol plans to undergo a detoxification program. Why is 24-hour professional supervision needed during this process? To support and motivate the client while they experience detoxification To check if the client is still abusing any substances while undergoing detoxification To monitor and intervene during the process because there may be uncomfortable and even fatal side effects To assess and maintain adequate nutritional intake during the withdrawal process
To monitor and intervene during the process because there may be uncomfortable and even fatal side effects Alcohol withdrawal has many uncomfortable and sometimes fatal side effects. Therefore, detoxification is available as a medically monitored program with 24-hour medical supervision based on the severity of symptoms and the presence of comorbid conditions. Supportive and motivational counseling is a continuous process that starts before the detoxification program and goes on throughout the treatment process. The client is cut off from any substances he or she might abuse while undergoing detoxification. It is important to monitor if the metabolic needs are met, but 24-hour professional supervision is not needed for that.
