Substance Abuse, Eating Disorders, -NCLEX

"The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority?

"2. Exploring the nurse's own feelings about suicide

Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?

"2. Rejection by peers

"Which of the following groups are considered to be at highest risk for suicide?

1. Adolescents, men older than age 45, and people who have made previous suicide attempts"

The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

1. Providing one-on-one supervision during meals and for 1 hour afterward

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

1. check the client frequently at irregular intervals throughout the night.

"A 15-year-old client is admitted for treatment of bulimia nervosa. Which intervention is a critical component in the care plan?

2. Monitoring the client for purging behaviors

After a 33-year-old male client displays violent behavior, he is placed in restraints. Which intervention by the nurse takes priority for this client?

3. Continuously monitoring the client

A nurse is caring for a 23-year-old client who was diagnosed with anorexia nervosa at the age of 14. The client continues to have fear related to eating. She admits that she has been using laxatives daily and occasionally will self-induce vomiting after eating. She is 5 feet 5 inches tall and weighs 100 pounds. The nurse expects to find which physical manifestations?

3. Hypotension and hypothermia

An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

3. Lack of self-esteem, strong dependency needs, and impulsive behavior

The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

3. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.

A psychiatric facility uses a team approach in caring for its clients. Which of the following interventions takes priority when using this approach for a 14-year-old male client diagnosed with bulimia nervosa?

3. Meeting with team members daily to discuss the client's maladaptive behaviors"

A client being treated for morbid obesity is 5' 3" tall and weighs 250 lb (113.4 kg). She has lost 60 lb (27 kg) over the past year. A nurse is advising the client about adding an exercise regimen to her diet program. Which exercise is the most appropriate for the nurse to suggest?

3. Walking for 20 minutes per day

The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:

3. identify anxiety-causing situations.

During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on his forearms. What is the most appropriate way for the nurse to respond?

4. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."

A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?

4. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.

The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional data collection finding would suggest that the woman has an eating disorder?

4. Excessive and ritualized exercise"

A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings?

4. Provide objective data and feedback regarding the client's weight and attractiveness

The nurse is caring for a client who has been abusing opiates. Data collection findings in a client abusing opiates such as morphine include:

4. euphoria and constricted pupils.

"Victims of domestic violence should be assessed for what important information?

"2. Readiness to leave the perpetrator and knowledge of resources

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

"3. Set up a strict eating plan for the client.

During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response?

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

"Which task is most important when developing a plan of care for a client with anorexia nervosa?

"4. Evaluating exercise activities

A client with anorexia nervosa describes herself as "a whale." However, the nurse's data collection reveals that the client is 5' 8" (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should be included in the plan of care?

"4. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

The nurse is caring for a client who exhibits pinpoint pupils and decreased blood pressure, pulse, respirations, and temperature. These signs may indicate which disorder?

"1. Opiate intoxication

A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:

"1. antisocial personality disorder.

A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5' 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which approach should the nurse take first when caring for this client?

"2. Establish a trusting relationship with the client.

A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5' 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that lately she has had trouble eating and that she can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:

"2. anorexia nervosa.

A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:

"2. gain control of one part of her life.

"Which client is at highest risk for suicide?

2. One who plans a violent death and has the means readily available

"Which nursing diagnosis takes priority for a client diagnosed with anorexia nervosa?

3. Imbalanced nutrition: Less than body requirements

The nurse is collecting data on a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?

3. Parotid gland tenderness

(SELECT ALL THAT APPLY) Which of the following interventions would be supportive for a client with a nursing diagnosis of Imbalanced nutrition: Consuming less than the body requires due to dysfunctional eating patterns?

"1. Provide small, frequent feedings. 2. Monitor weight gain. 4. Encourage journaling to promote the expression of feelings. 5. Monitor the client at mealtimes and for 1 hour after meals."

In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?

"2. Calling a security guard and another staff member for assistance

A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?

3. The child doesn't cry when the shoulder is examined.

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

3. methadone.

A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is an appropriate response?

" ""You told me you got fired from your last job for missing too many days after taking drugs at night.""

Which nursing action is best when trying to diffuse a client's impending violent behavior?

1. Helping the client identify and express feelings of anxiety and anger

Which nursing interventions should be included in the treatment plan of a client diagnosed with bulimia nervosa?

1. Establish a contract with the client that specifies the amounts and types of food she must eat at each meal. 4. Reward the client for satisfactory weight gain.

(SELECT ALL THAT APPLY) While collecting data on a client the nurse observes symptoms that lead her to suspect opioid withdrawal. Which symptoms would the client likely exhibit?

1. Flushing 2. Piloerection 3. Nausea 4. Vomiting 5. Abdominal cramps"

The mother of a 3-year-old child is complaining that her son still throws temper tantrums when he doesn't get his way. How should the nurse advise the mother to respond?

1. Tell the mother to ignore the child because eventually he will stop having temper tantrums."

When interviewing the parents of an injured child, which of the following is an indicator that child abuse may be a problem?

1. The injury isn't consistent with the history or the child's age.

For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?

1. They tend to overprotect their children."

While collecting data on a client who was diagnosed with impulse control disorder (and who displays violent, aggressive, and assaultive behavior), the nurse can expect to find which of the following assessments?

1. client functions well in other areas of his life 2. The degree of aggressiveness is out of proportion to the stressor. 4. The client has a history of parental alcoholism and a chaotic, abusive family life.

An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:

1. violence on television.

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?

"3. ""I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls.""

"During which phase of alcoholism is loss of control and physical dependence evident?

"3. Crucial phase

A 23-year-old client with a history of bulimia states, "I can eat anything I want and never gain weight." After the evening meal, a nurse hears the client in the bathroom vomiting. Which action should the nurse take first?

"3. Encourage the client to go for a walk.

A nurse is assessing a client with a history of multiple substance abuse. The client reports that he's been experiencing nausea, vomiting, and diarrhea. The nurse observes flushing, piloerection, increased lacrimation, and rhinorrhea. These signs and symptoms most likely indicate withdrawal from what substance?

"3. Opioids

One of the goals for a client with anorexia nervosa is that the client will demonstrate increased coping by responding to stress in constructive ways. Which of the following actions is a positive indicator that the client is working toward meeting the goal?

"3. The client keeps a journal and discusses it with the nurse.

A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:

"3. domestic violence and abuse span all socioeconomic classes.

A 16-year-old female was admitted to the hospital for treatment of anorexia nervosa. A nurse is teaching the client's mother about the disease process. The nurse recognizes that the teaching was effective when the mother states that anorexia nervosa is characterized by:

"3. refusal to maintain normal body weight.

"A psychiatric client becomes angry and verbally abusive to a nurse. What must the nurse do to handle this situation?

"4. Identify her own feelings or responses to anger.

A nurse enters the room of a client who has recently been diagnosed with anorexia nervosa and finds the client engaging in strenuous exercise. Which nursing action is most important?

"4. Offering to go on a walk with the client

A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should look for which behavioral clues?

"1. A rigid posture, restlessness, and glaring

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

"1. Initiating caloric and nutritional therapy as ordered

"The nurse is caring for a client who has bulimia. What is a common metabolic complication associated with bulimia?

"1. Metabolic alkalosis

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

"1. The client will establish adequate daily nutritional intake.