Substance Abuse, ED, Impulse control disorders

A nurse assists a student nurse conducting an interview with the family of a preschool 4-year-old boy who is often disruptive in his class, is difficult to engage, and rarely speaks. Which question, if asked by the student, would require intervention by the nurse?

"Has your child received all his childhood immunizations? There is evidence that childhood immunizations play a role in the development of autism."

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

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

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

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

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

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

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

Abstinence is the basis for successful treatment.

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

Administer a benzodiazepine as prescribed.

A nurse is teaching new staff members about groups considered at highest risk for suicide. Which group should the nurse emphasize?

Adolescents, those in chronic pain, and persons who are unemployed

On admission a client reports taking disulfiram as part of their home medications. What would the nurse need to be aware of when coordinating the client's other medications?

Avoid all products containing alcohol.

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

The client will establish adequate daily nutritional intake.

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

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

A client who had been drinking heavily over the weekend could not remember specific events of where the client had been or what the client had done. The nurse interprets this information as indicating that the client experienced which condition?

blackout

A new nurse has transferred to the chemical dependency rehabilitation unit. Which action if performed by the new nurse would warrant the charge nurse to intervene?

calling the Narcotics Anonymous group for the client

The wife of a client with alcohol dependency tells the nurse, "I'm tired of making excuses for him to his boss and coworkers when he can't make it into work. I believe him every time he says he's going to quit." The nurse recognizes the wife's statement as indicating which behavior?

enabling

A nurse is caring for a client who is experiencing alcohol withdrawal. Which assessment finding indicates the need for an as-needed dose of chlordiazepoxide?

heart rate of 120 to 140 beats/minute

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

keeping a personal journal and discussing it with the nurse

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

lorazepam (benzodiazepine)

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

nitroglycerin

The nurse is teaching a client about the use of nicotine gum for assistance with smoking cessation. Which instruction should be included?

perform meticulous oral care

A client recently admitted to the hospital with sharp, substernal chest pain suddenly reports palpitations. The client ultimately admits to using cocaine 1 hour before admission. The nurse should immediately assess the client's:

pulse rate and character.

Which outcome should the nurse use as the best measure to determine a client's progress in rehabilitation?

the number of drug-free days the client has

The nurse provides care to a client brought to the emergency department with injuries from a motor vehicle collision. An intravenous line was established by paramedics. The client is now refusing bloodwork, and the nurse suspects the client may have been driving while intoxicated. How should the nurse best address the client?

"Can I help answer any questions about having your blood drawn?"

In consultation with his outpatient psychiatrist, a client is admitted for detoxification from methadone. He states, "I got addicted to morphine for my chronic knee pain. Methadone worked for a long time. Since I had my knee replacement surgery 3 months ago and physical therapy, I do not think I need methadone anymore." It is important to discuss which information with this client? Select all that apply.

"Detoxification will likely occur with slowly decreasing doses of methadone." "You will be monitored closely for withdrawal symptoms and treated as needed." "Physical therapy and nonchemical pain management techniques can be prescribed if needed." "If you have knee stiffness or pain, it is likely to be managed by non-narcotic pain

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

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

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

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

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

Demonstrating control over aggressive behavior

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

Provide the client with a quiet room to sleep in.

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 child abuse?

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

During hospitalization, a client with bulimia stops purging but becomes fearful that she will gain weight. She tells the nurse, "I can't gain weight. I'm fat enough as it is. I'll be really disgusting if I get fatter." When responding to this client, which response by the nurse would be mosttherapeutic?

Use nonjudgmental and realistic comments.

A nurse is administering total parenteral nutrition (TPN) to a client hospitalized with severe anorexia nervosa. Which laboratory finding would alert the nurse to a potential problem?

decreased magnesium level

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

depression

A nurse is assigned to care for a client with anorexia nervosa. During the first 48 hours of treatment, which nursing intervention is most appropriate for this client?

providing one-on-one supervision during meals and for 1 hour afterward

A client struggling with a binge eating disorder tells a nurse, "I don't know why I eat the way I do each night." What question would be most helpful for the nurse to ask this client?

"What do you do when you feel stressed or upset?"

A client with a history of heroin addiction is admitted to the hospital intensive care unit with a diagnosis of opioid drug overdose. While talking with a nurse, the client's parent reports a plan to have his child declared legally incompetent. Which response by the nurse is mosttherapeutic?

"Your child is ill and can't make decisions about health care and safety right now, but this situation is temporary."

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

developing effective coping skills