Lippincott TEST 3: Personality Disorders, Substance-Related Disorders, Anxiety Disorders, and Anxiety-Related Disorders

1. A client has been diagnosed with Avoidant Personality Disorder. He reports loneliness, but has fears about making friends. He also reports anxiety about being rejected by others. In designing a long-term treatment plan, in what order, from first to last, should the nurse include the following? 1. Teach the client anxiety management and social skills. 2. Ask the client to join one of his chosen activities with the nurse and two other clients. 3. Talk with the client about his self-esteem and his fears. 4. Help the client make a list of small group activities at the center he would find interesting.

1. 3. Talk with the client about his self-esteem and his fears. 1. Teach the client anxiety management and social skills. 4. Help the client make a list of small group activities at the center he would find interesting. 2. Ask the client to join one of his chosen activities with the nurse and two other clients. The client needs a stepwise plan for developing a social life. He needs to first work on his self-esteem and reduce his fears of rejection before talking about how to decrease his anxiety and learning new social skills. Helping him chose interesting activities is important before suggesting an activity for him. Then he will be ready to try a structured activity with the nurse present for support and role modeling.

10. A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client: 1. "You're a 28-year-old adult now, not a child who needs to be cared for." 2. "Your parents won't be around forever.After all, they are getting older." 3. "Your parents need a break, and you need a break from them."" Your parents have been supportive and will continue to be even if you live apart."

10. 4. Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart ," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth . Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.

100. A client approaches the medication nurse and states, "I can't believe you are NOT helping me with my cravings for my fentanyl patches! When I got off alcohol 2 years ago, they gave me naltrexone for my cravings, and it really helped. I can't stand the cravings and back pain anymore, and I'm getting angry." Which of the following responses by thenurse would be helpful for this client? Select all that apply. " Naltrexone does help decrease the cravings for alcohol." "Naltrexone can interfere with opiate cravings in some clients." "Cravings are hard to deal with, especially when you are in pain too." "I hear your frustration about how your detoxification is going." 5. "I am positive naltrexone can help with your cravings for fentanyl." "I can ask your physician if he thinks naltrexone might help you."

100. 1, 2, 3, 4, 6. Acknowledgment of the client's frustration, pain, and cravings is important to decrease the client's anger . Naltrexone can help with detoxification from alcohol and opiates. Asking the physician about the possibility of adding naltrexone is appropriate. The nurse can never promise that a medication will help this client, since naltrexone is effective with only 20% to 30% of clients with opiate cravings.

11. A client moves in with her family after her boyfriend of 4 weeks told her to leave. She is admitted to the subacute unit after reporting feeling empty and lonely, being unable to sleep, and eating very little for the last week. Her arms are scarred from frequent self-mutilation. The nurse should do which of the following from first to last? 1. Monitor for suicide and self-mutilation. 2. Discuss the issues of loneliness and emptiness. 3. Monitor sleeping and eating behaviors. 4. Discuss her housing options for after discharge.

11. 1. Monitor for suicide and self-mutilation. 3. Monitor sleeping and eating behaviors. 2. Discuss the issues of loneliness and emptiness. 4. Discuss her housing options for after discharge. Safety is the priority concern and then eating and sleeping patterns need to be reestablished. After intervening to meet basicneeds, delving into the loneliness and emptiness are important for determining underlying issues that need to be followed up in outpatient counseling. Although the client is living with her family currently, other options might be appropriate for her to consider. CN: Safety

12. The client approaches various staff with numerous requests and needs to the point of disrupting the staff's work with other clients. The nurse meets with the staff to decide on a consistent , therapeutic approach for this client. Which of the following approaches will be most effective? 1. Telling the client to stay in his room until staff approach him. 2. Limiting the client to the dayroom and dining area. 3. Giving the client a list of permissible requests. Having the client address needs to the staff person assigned.

12. 4. For the client with attention-seeking behaviors, the nurse would institute a behavioral contract with the client to help decrease dysfunctional behaviors and promote self-sufficiency. Having the client approach only his assigned staff person sets limits on his attention-seeking behavior. Telling the client to stay in his room until staff approach him, limiting the client to a certain area, or giving the client a list of permissible requests is punitive and does nothing to help the client gain control over the dysfunctional behavior.

13. The client with diagnosed borderline personality disorder tells the nurse, "You're the best nurse here. I can talk to you and you listen. You're the only one here that can help me." Which of the following responses by the nurse is most therapeutic? 1. "Thank you; you're a good person." "All of the nurses here provide good care." 3. "Other clients have told me that too." 4. "Mary and Sam are good nurses too."

13. 2. The most therapeutic response is, "All of the nurses here provide good care ." This statement corrects the client's unrealistic and exaggerated perception. "Splitting," defined as the inability to integrate good and bad aspects of an individual and the self, is a hallmark behavior of a client with borderline personality disorder. The client sees himself and others as all good or all bad. Components of "splitting" include behaviors that idealize anddevalue others. It is a defense that allows the client to avoid pain and feelings associated with past abuse or a current situation involving the threat of rejection or abandonment. The other statements promote the client's idealistic view and do nothing to help correct the client's distortion.

14. The client diagnosed with borderline personality disorder is admitted to the unit after having attempted to cut her wrists with a pair of scissors. The client has several scars on both arms from self-mutilation and suicide gestures. A staff member states to the nurse, "It's just attention that she wants, she's not going to kill herself." The nurse should respond to the staff member by saying: 1. "She's here now and we have to do our best." 2. "She needs to be here until she can control her behavior." 3. "I'm ashamed of you; you know better than to say that." "Any attempt at self-harm is serious, and safety is a priority."

14. 4. The client with borderline personality disorder is usually in a crisis situation when hospitalized for self-mutilation and suicidal ideation or behavior . The statement, "Any attempt at self-harm is serious and safety is a priority," is the best response because the misperception that self-mutilation is used to gain attention can result in death of the client. The client can accidentally commit suicide. Any form of self-harm is an indication that the client needs treatment. The statement, "She's here now and we have to do our best," is not helpful and does not educate the staff member about the client's needs. The statement, "She needs to be here until she can control her behavior," may be true but does not provide information about the client's priority needs . The statement, "I'm ashamed of you; you know better than to say that," is punitive , diminishes self-worth, and may not be a correct assumption of the staff member's knowledge.

15. The nurse assesses a client to be at risk for self-mutilation and implements a safety contract with the client. Which of the following client behaviors indicate that the contract is working? 1. The client withdraws to his room when feeling overwhelmed. The client notifies staff when anxiety is increasing. 3. The client suppresses his feelings when angry. 4. The client displaces his feelings onto the primary health care provider.

15. 2. For the client who is at risk for self-mutilation, the nurse develops a contract toassist the client with assuming responsibility for his behavior and to help the client develop adaptive methods of coping with feelings. Self-mutilation is usually an expression of intense anxiety, anger, helplessness, or guilt or a means to block psychological pain by inducing physical pain . A typical contract helpful to the client would have the client notify staff when anxiety is increasing. Withdrawing to his room when feeling overwhelmed, suppressing feelings when angry, or displacing feelings onto the primary health care provider is not an adaptive method to help the client deal with his feelings and could still result in self -mutilation.

16. The client diagnosed with borderline personality disorder who is to be discharged soon threatens to "do something" to herself if discharged. The nurse should first: 1. Request that the client's discharge be canceled. 2. Ignore the client's statement because it's a sign of manipulation. 3. Ask a family member to stay with the client at home temporarily . Discuss the meaning of the client's statement with her.

16. 4. Any suicidal statement must be assessed by the nurse . The nurse should discuss the client's statement with her to determine its meaning in terms of suicide , overwhelming feelings of anxiety, abandonment, or other need that the client cannot express appropriately. It is not uncommon for a client with borderline personality disorder to make threatening comments before discharge. Extending the hospital stay is inappropriate because it would encourage dependency and manipulation. Ignoring the client's statement on the assumption that it is a sign of manipulation is an error in judgment. Asking a family member to stay with the client temporarily at home is not appropriate andplaces the responsibility for the client on the family instead of the client.

17. A 19-year-old client is admitted to a psychiatric unit with an Axis I diagnosis of alcohol abuse and an Axis II diagnosis of personality disorder not otherwise specified. The client's mother states, "He's always in trouble, just like when he was a boy. Now he's just a bigger prankster and out of control." In view of the client's history, which of the following is most important initially? 1. Letting the client know the staff has theauthority to subdue him if he gets unruly. 2. Keeping the client isolated from other clients until he is better known by the staff. 3. Emphasizing to the client that he will have to pay for any damage he causes. Closely observing the client's behavior to establish a baseline pattern of functioning.

17. 4. The best initial course of action when admitting a client is to observe him to establish baseline information. This assessment provides valuable information about the client's behavior and forms the basis for the plan of care. Telling the client that the staff has authority to subdue him if he gets unruly or that he will have to pay for any damage he causes is threatening and may incite or provoke trouble. Isolating a client is not recommended unless there is a very good reason for it, such as a very active, combative client who is dangerous to himself and others.

18. The client tells the nurse at the outpatient clinic that she doesn't need to attend groups because she's "not a regular like these other people here." The nurse should respond to the client by saying: 1. "Because you're not a regular client, sit in the hall when the others are in group." 2. "Your family wants you to attend, and they will be very disappointed if you don't." 3. "I'll have to mark you absent from the clinic today and speak to the doctor about it." "You say you're not a regular here, but you're experiencing what others are experiencing."

18. 4. The best response is, "You say you're not a regular here, but you're experiencing what others are experiencing." This statement helps the client to identify factors that precipitate denial by helping her to confront that which inhibits compliance. Denial is used to help a client feel better and more secure when a situation provokes a high level of anxiety and is threatening to the client. The statement, "Because you're not a regular client, sit in the hall when the others are in group," agrees with and promotes denial in the client and interferes with treatment. The statement, "Your family wants you to attend and they will be disappointedyou don't," causes the client to feel guilty and decreases her self-esteem. The statement, "I'll have to mark you absent from the clinic today and speak to the doctor about it," is punitive and threatening to the client , subsequently decreasing her self-esteem.

19. The client who has a history of using angry outbursts when frustrated begins to curse at the nurse during an appointment after being informed that she will have to wait to have her medication refilled. Which of the following responses by the nurse is most appropriate? 1. "You're being very childish." 2. "I'm sorry if you can't wait." "I will not continue to talk with you if you curse." 4. "Come back tomorrow and your medication will be ready."

19. 3. Stating, "I will not continue to talk with you if you curse," sets limits on the client's behavior and points out the negative effects of her behavior . Therefore, this response is most appropriate and therapeutic. The statement, "You're being very childish," reprimands the client, possibly causing the anger to escalate. The statement, "I'm sorry if you can't wait," fails to provide feedback to the client about her behavior . The statement , "Come back tomorrow and your medication will be ready," ignores the client's behavior , failing to provide feedback to the client about the behavior. It also shows poor nursing judgment because the client may need her medication before tomorrow or may not return to the clinic the following day.

27. In an outpatient addictions group, a recovering client said that before her treatment, her husband drank on social occasions. "Now he drinks at home, from the time he comes home from work until he goes to bed. He says that he doesn't like me anymore and that I expect him to do morework on the house and yard. I use to ignore that stuff. I don't know what to do." The nurse would make the following comments in which order of priority from first to last? 1. "What do you think you could do to have your husband come in for an evaluation?" 2. "I hear how confused and frustrated you are." 3. "It can happen that as one person sobers up, the spouse deteriorates." 4. "What have you tried to do about your husband's behaviors?"

2. "I hear how confused and frustrated you are." 3. "It can happen that as one person sobers up, the spouse deteriorates." 4. "What have you tried to do about your husband's behaviors?" 1. "What do you think you could do to have your husband come in for an evaluation?" The client's feelings and concerns need to be validated, so that she will open up more. She also should know that the changes in her husband are not unusual. It helps to know the client has tried with her husband to determine if they are appropriate or not. Then there can be a discussion about getting help for her husband, so that her efforts to stay sober are not compromised.

2. A client diagnosed with borderline personality disorder has self-inflicted cuts on her arms. The nurse is assessing the client for the risk of suicide. What should the nurse ask the client first? 1. About medications she has taken recently . 2. If she is taking antidepressants. If she has a suicide plan. 4. Why she cut herself.

2. 3. The client is at risk for suicide, and the nurse should determine how serious the client is, including if she has a plan and the means to implement the plan. Whilemedication history may be important, the nurse should first attempt to determine suicide risk. Asking the client why she cut herself will likely cause the client to respond with insufficient information to determine suicide risk.

20. Which of the following behaviors indicates to the nurse that the client diagnosed with avoidant personality disorder is improving? Interacting with two other clients . 2. Listening to music with headphones. 3. Sitting at a table and painting. 4. Talking on the telephone.

20. 1. The client with avoidant personality disorder is showing signs of improvement when interacting with two other clients. A client with avoidant personality disorder is timid, socially uncomfortable, withdrawn, and hypersensitive to criticism. Social contact with others decreases isolation and withdrawal. Listening to music withheadphones, sitting at a table and painting , and talking on the telephone are solitary activities and therefore do not indicate improvement, which is evidenced by social contact.

21. One evening the client takes the nurse aside and whispers, "Don't tell anybody, but I'm going to call in a bomb threat to this hospital tonight ." Which of the following actions is the priority? 1. Warning the client that his telephone privileges will be taken away if he abuses them. 2. Offering to disregard the client's plan if he does not go through with it. 3. Notifying the proper authorities after saying nothing until the client has actually completed the call. Explaining to the client that this information will have to be shared immediately with the staff and the primary health care provider.

21. 4. The priority is to explain to the client that this information has to be shared immediately with the staff and the primary health care provider because of its serious nature. Safety of all is crucial regardless of whether the client follows through on his plan. It is possible that the client is asking to be stopped and that he is indirectly pleading for help in a dysfunctional manner. Bargaining with the client, such as warning him that his telephone privileges will be taken away if he abuses them or offering to disregard his plan if he does not go through with it, is inappropriate. Saying nothing to anyone until the client has actually completed the call and then notifying the proper authorities represent serious negligence on the part of the nurse.

22. When teaching a nursing assistant new to the unit about the principles for the care of a client diagnosed with a personality disorder, the nurse should explain that: The clients are accepted although theirbehavior may not be . 2. Clients need limits on their behavior. 3. The staff members are the primary ones left to care about these clients. 4. The staff should use minimal humor when working with these clients.

22. 1. The most basic and important idea to convey to a client is that, as a person, he or she is accepted, although his or her behavior may not be. Empathy is conveyed for emotional pain regardless of the client's behavior. Although some clients need limits placed on their behavior , not all clients require limit setting. That the staff membersare the primary ones left to care about these clients is not necessarily true, nor is it true that the staff should use very little humor with these clients. Clients who are rigid and perfectionists and who have a restricted affect may need help with displaying humor.

23. The nurse is talking with a client who has been diagnosed with antisocial personality disorder about how to socialize during activities without being seductive. The nurse should focus the discussion on which of the following areas? Explaining the negative reactions of others toward his behavior. 2. Suggesting he apologize to others for his behavior. 3. Asking him to explain the reasons for his seductive behavior. 4. Discussing his relationship with his mother.

23. 1. The nurse should explain the negative reactions of others toward the client's behaviors to make him aware of the impact of his seductive behaviors on others . Suggesting that the client apologize to others for his behavior is futile because the client cannot feel remorse for wrongdoing. Asking him to explain reasons for his seductive behavior is not helpful because this client is skillful at using projection and rationalization. Discussing his relationship with his mother is not helpful because the focus should be oriented to the present situation and managing his behavior at the present time.

24. Which of the following approaches is most appropriate to use with a client diagnosed with a narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? 1. Limit setting. Supportive confrontation. 3. Consistency. 4. Rationalization.

24. 2. The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. Limit setting and consistency also may be used. However , limit setting helps the client control unacceptable behavior and consistency helps reduce the frequency of negative behaviors ; they do not point out discrepancies. Rationalization is typically used by the client ,not the nurse, to blame others, make excuses , and provide alibis for self-centered behaviors.

25. The client with histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. The nurse should recommend which of the following activities for this client? 1. Party planning . 2. Music group. 3. Cooking class. Role-playing.

25. 4. The nurse should use role playing to teach the client appropriate responses to others in various situations. This client dramatizes events, draws attention to self , and is unaware of and does not deal with feelings. The nurse works to help the client clarify true feelings and learn to express them appropriately. Party planning, music group, and cooking class are therapeutic activities , but will not help the client specifically learn how to respond appropriately to others.

28. For the client who has difficulty falling asleep at night because of withdrawal symptoms from alcohol, which are abating , which of the following nursing interventions is likely to be most effective? 1. Inviting the client to play a board game with the nurse. 2. Allowing the client to sit in the community room until the client feels sleepy. 3. Advising the client to sleep on the sofa in the dayroom. Teaching the client relaxation exercises to use before bedtime.

28. 4. The best action by the nurse to help a client who has difficulty falling asleep would be to teach the client relaxation exercises to use before bedtime to reduce anxiety and promote relaxation. This activity will also be useful for the client when out of the hospital. Inviting the client to play a board game is inappropriate because this activity can be competitive and thus stimulate the client. Allowing the client to sit in the community room until she feels sleepy is inappropriate because it does nothing to help the client relax; nor does advising theclient to sleep on the sofa in the dayroom, which may be against unit policy.

29. A client known to have alcohol dependence is admitted to the emergency department with a temperature of 99 ° F (37.2 ° C), a pulse of 110, respirations of 26 , and blood pressure of 150/ 98. The blood alcohol level is 0.25%, three times the legal limit. Now the client is becoming belligerent and uncooperative. In which order from first to last should the following nursing and medical prescriptions be implemented? 1. Administer lorazepam 2 mg IM. 2. Draw blood for a magnesium level. 3. Take vital signs every 15 minutes . 4. Place the client in a quiet room with dimmed lights.

29. 4. Place client in a quiet room with dimmed lights. 1. Administer lorazepam 2 mg IM 2. Draw blood for a magnesium level. 3. Take vital signs every 15 minutes. The nurse should first place the client in a quieter, darkened room with dimmer lights to decrease the stimuli from the busy emergency department (ED) and create a more calming environment. Next, the nurse should administer the lorazepam to help decrease agitation and reduce the risk of seizures. Drawing the blood will be easier as the client becomes less agitated. Depending on the magnesium blood level, the client may need an intramuscular (IM) dose of magnesium sulfate to prevent seizures. The nurse can then obtain the vital sign every 15 minutes to determine if the client is becoming stabilized and if the client needs further doses of lorazepam.

3. When developing the plan of care for a client diagnosed with a personality disorder , the nurse plans to assist the client primarily with which of the following? Specific dysfunctional behaviors. 2. Psychopharmacologic compliance. 3. Examination of developmental conflicts . 4. Manipulation of the environment. 4. A client diagnosed with paranoid

3. 1. The nurse should plan to assist the client who has a personality disorder primarily with specific dysfunctional behaviors that are distressing to the client or others. The client with a personality disorder has lifelong, inflexible, and dysfunctional patterns of relating and behaving. The client commonly does not view his behavior as distressful to himself. The client becomes distressed because of others' reactions and behaviors toward him, which cause the client emotional pain and discomfort. Psychopharmacologic compliance is not a primary need because medication does not cure a personality disorder. Medication is prescribed if the client has a severe symptom that interferes with functioning, such as severe anxiety or depression, or if the client has an Axis I disorder. Examination of developmental conflicts usually is not helpful because of the ingrained dysfunctional ways of thinking and behaving. It is more useful to help the client with changing dysfunctional behaviors. Although milieu management is a component of care, the client usually is proficient in manipulation of the environment to meet his needs.

30. A client has been admitted to the emergency department with alcohol withdrawal delirium. The nurse is assessing the client for signs of withdrawal. At 9 am on 10/ 25, the nurse notes that the client is confused. Vital signs are T = 99 ° F (37.2 ° C), P = 50, R = 10, and BP = 100/ 60. The nurse compares these findings to the nurses ' progress notes from admission 24 hours ago (see below). What should the nurse do first? Contact the primary health care provider. 2. Increase the rate of the IV infusion. 3. Attempt to arouse the client. 4. Administer magnesium sulfate.

30. 1. The nurse should first contact the primary health care provider. The client's vital signs and level of consciousness are deteriorating, indicating complications ofwithdrawal, which can be life threatening . Increasing the rate of the infusion may cause fluid overload and has not been prescribed by the primary health care provider. Arousing the client will not address the underlying problems. Magnesium sulfate is used to treat seizures precipitated by alcohol withdrawal, but the client is not demonstrating signs of actual or impending seizures.

31. An intoxicated client is admitted to the hospital for alcohol withdrawal. Which of the following should the nurse do to help the client become sober? 1. Give the client black coffee to drink. 2. Walk the client around the unit. 3. Have the client take a cold shower. Provide the client with a quiet room to sleep in.

31. 4. The nurse should provide the client with a quiet room to sleep in. Alcohol is destroyed and oxidized in the body at a slow, steady rate. The rate of alcohol metabolism is not influenced by drinking black coffee , walking around the unit, or taking a cold shower. Therefore, it is best to have the client sleep off the effects of the alcohol.

32. The client is admitted to the hospital for alcohol detoxification. Which of the following interventions should the nurse use? Select all that apply. Taking vital signs. Monitoring intake and output. 3. Placing the client in restraints as a safety measure. Reinforcing reality if the client is disoriented or hallucinating. Explaining to the client that the symptoms of withdrawal are temporary.

32. 1, 2, 4, 5. For the client experiencing symptoms of alcohol withdrawal, the nurse monitors vital signs and intake and output, reinforces reality for the client who is confused, disoriented, or hallucinating , explains that the symptoms of withdrawal are temporary, reduces stimulation, and stays with the client if he is confused or agitated. The nurse administers medications to prevent the progression of symptoms, such as seizures and delirium tremens, and to ensure the client's safety. Restraints are not used as a precautionary measure. Restraints are used only as a least restrictive measure to protectthe client and others when the client is a danger to himself or others.

33. The nurse is assessing a client who has fallen twice in the last 2 days. The client has been diagnosed with delirium tremens (DTs) following withdrawal from alcohol use . The nurse should further evaluate the client for which of the following? Select all that Disorientation . 2. Paralysis. Elevated temperature. Diaphoresis. Visual or auditory hallucinations.

33. 1, 3, 4, 5. Two or three days after cessation of alcohol, clients may experience delirium tremens (DTs), as evidenced by disorientation, nightmares , abdominal pain, nausea, and diaphoresis, as well as elevated temperature, pulse, and blood pressure, and visual and auditory hallucinations. If the client had a traumatic brain injury after falling, the client might have paralysis, but there is no association of paralysis from DTs.

34. A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later he reports having insomnia , shakiness, sweating, and one seizure. The nurse should first ask the client if he: 1. Has been drinking alcohol with the clonazepam. 2. Has developed tolerance to the clonazepam and needs to increase the dose. Has stopped taking the clonazepam suddenly. 4. Is having a panic attack and needs to take an extra clonazepam.

34. 3. The nurse should first confirm that the client has stopped taking the clonazepam because the client is reporting symptoms of benzodiazepine withdrawal from stopping the clonazepam abruptly. The client would report symptoms of being sedated if he took alcohol with the clonazepam. Tolerance symptoms would be increased anxiety, not these physical symptoms. Clonazepam is an appropriate medication for panic attacks, but taking extra pills without primary health care provider approval is not appropriate.

35. A client is entering the chemical dependency unit for treatment of alcohol dependency. Which of the client's possessions should the nurse place in a locked area? 1. Toothpaste. 2. Dental floss. 3. Shaving cream. Antiseptic mouthwash.

35. 4. Antiseptic mouthwash commonly contains alcohol and should be kept in a locked area unless labeling clearly indicates that the product does not contain alcohol. Aclient with an intense craving for alcohol may drink mouthwash that contains alcohol. Personal care items, such as toothpaste , dental floss, and shaving cream, do not contain alcohol, and the client would be allowed to keep them in the room.

36. A client is entering rehabilitation for alcohol dependency as an alternative to going to jail for multiple DUIs (driving under the influence). While obtaining the client's history, the nurse asks about the amount of alcohol he consumes daily. He responds,just have a few drinks with the guys after work." Which of the following responses by the nurse is most therapeutic? 1. "That's what all the clients here say at first." 2. "Then you should have had a designated driver for yourself." 3. "I guess you just can't handle a few drinks."" You say you have a few drinks, but you have multiple arrests."

36. 4. The best way to intervene with a client's minimization or denial of alcohol problems is to point out the consequences of the drinking— the multiple arrests. The other responses are superficial and discount the seriousness of the client's problem.

37. While admitting a client to the alcohol treatment program, the nurse asks the client how long she's been drinking, how much she's been drinking, and when she had her last drink. The client replies that she has been drinking about a liter of vodka a day for the past week and her last drink was about an hour ago. This information helps the nurse to determine which of the following? 1. The severity of the disease. The severity of withdrawal symptoms. 3. The possibility of alcoholic hallucinosis. 4. The occurrence of delirium tremens.

37. 2. The client's response helps the nurse determine the severity of withdrawal symptoms because the length and extent of drinking alcohol has an effect on the severity of symptoms the client experiences during withdrawal. Decreased use of alcohol can also result in withdrawal symptoms in the client who has developed a high tolerance to alcohol and is physically dependent. The severity of the disease , the possibility of hallucinations, and the occurrence of delirium tremens are not determined by the information given. The Axis I diagnosis of alcohol dependency is just that— it is not classified as mild, moderate, or severe. Alcoholic hallucinosis is a state of auditory hallucinations that develops about 48 hours after the client has stopped drinking. The client hears voices or noises within thecontext of a clear sensorium, meaning that the auditory hallucination is the only symptom the client experiences. Severe withdrawal symptoms that are not managed medically can progress to delirium tremens or a severe abstinence syndrome. Delirium tremens occurs about 3 to 5 days after the client's last drink and is characterized by confusion, agitation, severe psychomotor activity, hallucinations, sleeplessness, tachycardia, elevated blood pressure, elevated temperature, and possibly seizures.

38. A client who is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/ 87 mm Hg and pulse is 92 bpm. Which of the following medications should the nurse expect to administer? 1. Haloperidol (Haldol). Lorazepam (Ativan). 3. Benztropine (Cogentin). 4. Naloxone (Narcan).

38. 2. The nurse would most likely administer a benzodiazepine, such as lorazepam, to the client who is experiencing symptoms of alcohol withdrawal. The benzodiazepine substitutes for the alcohol to suppress withdrawal symptoms. The client experiences symptoms of withdrawal because of the "rebound phenomenon " when sedation of the central nervous system (CNS) from alcohol begins to decrease. Haloperidol (Haldol) is an antipsychotic and is not indicated for alcohol withdrawal symptoms. Benztropine is used to treat extrapyramidal symptoms associated with antipsychotic therapy. Naloxone is used in opioid overdose to reverse the CNS depression caused by the opioid. CN:

39. Which of the following assessmentsprovides the best information about the client's physiologic response and the effectiveness of the medication prescribed specifically for alcohol withdrawal? 1. Nutritional status. 2. Evidence of tremors. Vital signs. 4. Sleep pattern.

39. 3. Monitoring vital signs provides the best information about the client's overallphysiologic status during alcohol withdrawal and the physiologic response to the medication used. Vital signs reflect the degree of central nervous system irritability and indicate the effectiveness of the medication in easing withdrawal symptoms. Although assessment of nutritional status and sleep pattern and assessment for evidence of tremors are important, they provide only indirect information about single aspects of the client's physiologic status.

4. A client diagnosed with paranoid personality disorder is hospitalized for physically threatening his wife because he suspects her of having an affair with a coworker. Which of the following approaches should the nurse employ with this client? 1. Authoritarian. 2. Parental. Matter-of-fact. 4. Controlling.

4. 3. For this client, the nurse needs to use a calm, matter-of-fact approach to create a nonthreatening and secure environment because the client is experiencing problems with suspiciousness and trust. Use of " I" statements and responses would be therapeutic to reduce the client's suspiciousness and increase his trust in the staff and the environment. An authoritarian approach is nontherapeutic and inappropriate because the client may perceive this approach as an attack , subsequently responding with anger and threatening behavior. A parental or controlling approach may be perceived as authoritarian, and the client may become defensive and angry.

40. A client who had been drinking heavily over the weekend could not remember specific events of where he had been or what he had done. The nurse interprets this information as indicating that the client experienced which of the following conditions? Blackout. 2. Hangover. 3. Tolerance. 4. Delirium tremens.

40. 1. A client is suffering from a blackout when he cannot recall what he did while under the influence of alcohol. A hangover refers to symptoms experienced the day after a bout of heavy drinking. Common symptoms include headaches and gastrointestinal distress, typically after heavy alcohol consumption. Tolerance refers to the need to increase the amount of the substance or to ingest the substance more often to achieve the same effects . Delirium tremens refers to severe alcohol withdrawal or abstinence syndrome with confusion, psychomotor agitation, sleeplessness, hallucinations, and elevated vital signs. CN: Physiological

41. A client is entering the alcohol treatment program for the fourth time in 5 years. Which of the following statements by the nurse will be most helpful to the client? 1. "I hope you are serious about maintaining your sobriety this time." 2. "I'm Maria, a nurse here. I don't know you from past attempts, but you'll get it right this time." 3. "I know someone who was successful after the fifth program." "I'm Maria, a nurse in the program. The staff and I will help you through the program."

41. 4. Stating, "I'm Maria, a nurse in the program; the staff and I will help you," is a nonjudgmental, caring approach that promotes trust and a therapeuticrelationship. The statement, "I hope you are serious about maintaining your sobriety this time," blames the client, subsequently decreasing the client's self-worth. Saying, "You'll get it right this time" is threatening to the client, possibly leading to decreased self -worth by reinforcing the client's past failures at maintaining sobriety. The statement, "I know someone who was successful after the fifth program," is impersonal and irrelevant to the client's situation.

42. The wife of a client with alcohol dependency tells the nurse, "I'm tired ofmaking 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 of the following behaviors? 1. Helpfulness. 2. Self-defeat. Enabling. 4. Masochism.

42. 3. The wife of the man with alcohol dependency is exhibiting enabling behavior when she makes excuses for her husband's absenteeism. Enabling behavior is not helpful to the client but rescues him from adverse consequences in relation to his employment . Self-defeating behavior would be evidenced by putting oneself in a position that will lead to failure. Masochistic behavior would be evidenced by the need to experience emotional or physical pain to become sexually aroused.

43. Which of the following statements by the nurse participating in a group confrontation of a coworker is most helpful in reducing the coworker's denial about alcohol being a problem? 1. "Your behavior is unprofessional." 2. "As a nurse , you should have sought help earlier." 3. "Nurses are the worst when it comes to asking for help." "You have alcohol on your breath."

43. 4. To be most helpful, the nurse should calmly and objectively present facts by saying, "You have alcohol on your breath," to help the coworker overcome denial and resistance. This statement also helps to reinforce the coworker's awareness of the problem. The other statements blame the coworker and may reinforce denial. Blamingnagging, and yelling diminish self-esteem in the individual with a substance abuse problem who has low frustration tolerance.

44. The husband of a nurse who is being confronted by a group about her problem with alcohol asks the nurse acting as the group leader what he should say to his wife during the meeting. The nurse leader directs the husband to use which of the following statements to facilitate his wife's entrance into treatment? 1. "The children and I want you to get help." 2. "If your parents were alive, they would be extremely disappointed in you." "Either you get help or the kids and I will move out of the house." `4. "You need to enter treatment now or be a drunk if that's what you want."

44. 3. The nurse leader should direct the husband to say, "Either you get help or the kids and I will move out of the house." This statement facilitates entrance into treatment because it is a direct statement of what the consequences are if the alcohol abuse continues. The statement, "The children and I want you to get help ," is not effective. Most likely, the husband has already made a similar statement before the confrontation session. Saying, "If your parents were alive, they would be extremely disappointed in you," or "You need to enter treatment now or be a drunk if that's what you want," shames the wife and further decreases her self -esteem.

45. A nurse working in an alcohol rehabilitation program is teaching staff how to give clients constructive feedback. Which of the following statements given as an example illustrates that the staff member understands the nurse's teaching regarding the use of constructive feedback? 1. "I think you're a real con artist." 2. "You're dominating the conversation." "You interrupted Terry twice in 4 minutes." 4. "You don't give anyone a chance to finish talking."

45. 3. The statement, "You interrupted Terry twice in 4 minutes," indicates an understanding of the use of constructive feedback by describing specifically what was seen and heard in an objective manner. The other statements are judgmental and blame the client without specifying what the objectionable behavior is.

46. A client ashamedly tells the nurse that he hit his wife while intoxicated and asks the nurse if his wife will ever forgive him. The nurse should reply to the client by saying: 1. "Perhaps you could ask her and find out." 2. "That's something you can explore in family therapy." 3. "It would depend on how much she really cares for you." "You seem to have some feelings about hitting your wife."

46. 4. The client is feeling remorse abouthitting his wife. It is best to make a comment that will help him focus on his feelings and express them. Reflecting what the client has said is a good technique to accomplish these goals. Suggesting the client ask his wife or explore the issue in family therapy is inappropriate because it gives advice and ignores the client's underlying feelings. Saying "It would depend on how much she really cares for you" is inappropriate because it ignores the client's feelings and reinforces the negative aspects, such as the shamefulness, of the behavior.

47. While meeting with the nurse, a client's wife states, "I don't know what else to do to make him stop drinking." The nurse should refer the wife to which of the following organizations? 1. Alateen . Al-Anon. 3. Employee assistance program . 4. Alcoholics Anonymous.

47. 2. Al-Anon is a self-help group for spouses and significant others that provides education and support and helps participants learn to lead their own life without feeling responsible for the individual with an alcohol problem. Alateen provides support for teenaged children of a person with an alcohol problem. Employee assistance programs help employees recover from alcohol or drug dependence while retaining their positions or jobs. Alcoholics Anonymous provides support for the individual with alcohol problems to attain and maintain sobriety.

48. Which of the following nursing actions is contraindicated for the client who is experiencing severe symptoms of alcohol withdrawal? Helping the client walk. 2. Monitoring intake and output. 3. Assessing vital signs. 4. Using short, concrete statements.

48. 1. Having the client who is experiencing severe symptoms of alcohol withdrawal walk is contraindicated because increased activity and stimulation may confuse the client and promote hallucinations. The client may also sustain aninjury if he has a seizure as part of the alcohol withdrawal process. The nurse should monitor intake and output to ensure fluid and electrolyte balance and hydration. The nurse should assess vital signs to assess the physiologic status of the client and the response to medications. The nurse should use short, concrete statements to decrease confusion and ambiguity.

49. Which of the following client statements indicates to the nurse that the client needs further teaching about disulfiram (Antabuse)? "I can drink one or two beers and not get sick while on Antabuse." 2. "I can take Antabuse at bedtime if it makes me sleepy." 3. "A metallic or garlic taste in my mouth is normal when starting on Antabuse." 4. "I'll read the labels on cough syrup and mouthwash for possible alcohol content."

49. 1. Any amount of alcohol consumed while taking disulfiram (Antabuse) can cause an alcohol-disulfiram reaction. The reaction experienced is in proportion to the amount of alcohol ingested. The alcohol-disulfiram reaction can begin 5 to 10 minutes after alcohol is ingested. Symptoms can be mild, as in flushing, throbbing in the head and neck, nausea, and diaphoresis. Other symptoms include vomiting, respiratory difficulty, hypotension, vertigo, syncope, and confusion. Severe reactions involve respiratory depression, convulsions, coma, and even death. Disulfiram can be taken at bedtime if the client feels sleepy from the medication . Some clients experience a metallic or garlic taste when initiating disulfiram treatment. Anything containing alcohol, such as cough medicine, aftershave lotion, and mouthwash, can cause a reaction. Therefore, the client needs to check the labels of these items for their alcohol content.

5. When planning care for a client diagnosed with schizotypal personality disorder, which of the following helps the client become involved with others? 1. Participating solely in group activities. 2. Being involved with primarily one-to-one activities. 3. Leading a sing-along in the afternoon. Attending an activity with the nurse.

5. 4. Attending an activity with the nurse assists the client to become involved with others slowly. The client with a schizotypal personality disorder needs support, kindness, and gentle suggestion to improve social skills and interpersonal relationships. The client commonly has problems in thinking, perceiving, and communicating and appears similar to clients with schizophrenia except that psychotic episodes are infrequent and less severe. Participation solely in group activities or leading a sing-along would be too overwhelming for the client, subsequently increasing the client's anxiety andwithdrawal. Engaging primarily in one-to-one activities would not be helpful because of the client's difficulty with social skills and interpersonal relationships. However, activities with the nurse could be used to establish trust. Then the client could proceed to activities with others.

50. While receiving disulfiram (Antabuse) therapy, the client becomes nauseated and vomits severely. Which of the following questions should the nurse ask first? 1. "How long have you been taking Antabuse?" 2. "Do you feel like you have the flu?" "How much alcohol did you drink today?" 4. "Have you eaten any foods cooked in wine?"

50. 3. The first question should be to ask the client how much alcohol she has had today because nausea with severe vomiting is a sign of an alcohol-disulfiram (Antabuse) reaction. Asking the client whether she feels like she has flu symptoms is important after inquiring about alcohol intake. Foods cooked in an alcoholic beverage, such as wine, could also cause a reaction, but the reaction would be less severe because the alcohol dissipates with cooking. Asking how long the client has been taking Antabuse would be least important at this time.

51. The expected outcome for using thiamine for a client being treated for an alcohol addiction is to: Prevent the development of Wernicke's encephalopathy. 2. Decrease client's withdrawal symptoms. 3. Aid client in regaining strength sooner. 4. Promote elimination of alcohol from the body faster.

51. 1. Thiamine specifically prevents the development of Wernicke's encephalopathy, a reversible amnestic disorder caused by a diet deficient in thiamine secondary to poor nutritional intake that commonly accompanies chronic alcoholism. It is characterized by nystagmus, ataxia, and mental status changes. Because the client would rather drink alcohol than eat, the client is depleted of vitamins and nutrients. Alcohol also is an irritant that causes a "malabsorption syndrome" in which vitamins and nutrients are not absorbed properly in the gastrointestinal tract. Thiamine is not associated with decreasing withdrawal symptoms, helping clients regain their strength, or promoting elimination of alcohol from the body.

52. Which of the following client statements indicates an understanding of the signs of alcohol relapse? 1. "I know I can stay dry if my wife keeps alcohol out of the house." "Stopping Alcoholics Anonymous (AA) and not expressing feelings can lead to relapse." 3. "I'll have my sponsor at AA keep the list of symptoms for me." 4. "If someone tells me I'm about to relapse, I'll be sure to do something about it."

52. 2. The statement, "Stopping AA and not expressing feelings can lead to relapse," indicates the client's understanding of signs of relapse. The client is responsible for sobriety and must understand the signs of relapse. Other antecedents to relapse include severe craving, being around users, and severe emotional crises. The other statements place the responsibility for the client's sobriety on someone else. CN: Reduction of risk potential;

53. The client sees no connection between her liver disorder and her alcohol intake. She believes that she drinks very little and that her family is making something out of nothing. The nurse interprets these behaviors as indicative of the client's use of which of the following defense mechanisms? Denial. 2. Displacement. 3. Rationalization. 4. Reaction formation.

53. 1. The client is using denial, an unconscious defense mechanism, when she refuses to acknowledge that she has a problem with alcohol. This is further evidenced by the client's inability to connect the liver disorder with alcohol ingestion. Displacement involves transfer of a feeling to someone else or to an object. Rationalization involves an attempt to make or prove that one's feeling or behavior is justifiable. Reaction formation is a conscious behavior that is the exact opposite of an unconscious feeling.

54. Which of the following foods should the nurse eliminate from the diet of a client in alcohol withdrawal? 1. Milk. Regular coffee .3. Orange juice. 4. Eggs.

54. 2. Regular coffee contains caffeine, which acts as a psychomotor stimulant and leads to feelings of anxiety and agitation. Serving coffee to the client may add to tremors and wakefulness. Milk, orange juice , and eggs are part of a well-balanced, high-protein diet needed by the client in alcohol withdrawal, who is nutritionally depleted.

55. A client with alcohol dependency has peripheral neuropathy. The nurse should develop a teaching plan that emphasizes: 1. Washing and drying the feet daily. 2. Massaging the feet with lotion. 3. Trimming the toenails carefully. Avoiding use of an electric blanket.

55. 4. The nurse should teach the client with peripheral neuropathy to avoid using an electric blanket because the client is likely to have decreased sensitivity in the extremities owing to the damaging effects of alcohol on the nerve endings. It is particularly important to guard against burns because the client may not be able to discern the appropriate degree of heat on the feet. Daily washing and drying, massaging with lotion, and trimming the toenails are appropriate foot care measures for any client.

56. A client is experiencing alcohol withdrawal. He wakes up and screams , "There's something crawling under my skin. Help me." In which order, from first to last, should the following nursing actions be done? 1. Remind the client that he is having withdrawal symptoms and that these will be treated. 2. Administer a dose of lorazepam (Ativan) depending on the severity of the withdrawal symptoms. 3. Assess the client for other withdrawal symptoms. 4. Take the client's vital signs. 5. Chart the details of the episode on the electronic health record.

56. 1. Remind the client that he is having withdrawal symptoms and that these will be treated. 4. Take the client's vital signs depending on the severity of the withdrawal symptoms. 3. Assess the client for other withdrawal symptoms. 2. Administer a dose of lorazepam (Ativan). 5. Chart the details of the episode on the electronic health record. After the nurse reminds the client about this withdrawal symptom, the nurse should take the client's vital signs and then assess forother symptoms, such as visual and auditory disturbances, tremors, anxiety, nausea, and excess perspiration. The elevation of the vital signs also helps to determine the amount of Ativan needed to control the withdrawal symptoms. The nurse should then chart the details of the episode and outcomes of the interventions.

57. Which of the following measures should the nurse include in the plan of care for a client with alcohol withdrawal delirium? 1. Using restraints continuously. 2. Touching the client before saying anything. Remaining with the client when she is confused or disoriented. 4. Informing the client about alcohol treatment programs.

57. 3. The client with alcohol withdrawal delirium should not be left unattended when confused, disoriented, or hallucinating . Injury or unintentional suicide is a possibility when the client attempts to get away from hallucinations. Restraints are used only when the client loses control and is a danger to herself or others, to protect the client from injury or harm. Touching the client before saying anything is an additional stimulus that would most likely add to the client's agitation. Informing the client about the alcohol treatment program while the client is delirious is inappropriate and shows poor nursing judgment. The client should be given information about alcohol treatment when the withdrawal symptoms are lessening and the client can comprehend the information.

58. Which of the following is an accurate response when a client asks the nurse about requirements to become a member of Alcoholics Anonymous (AA)? 1. "You must be sober for at least a month before joining." "AA is open to anyone who wants sobriety." 3. "The members will interview you and decide if you can join the group." 4. "AA requires daily attendance at meetings."

58. 2. Alcoholics Anonymous (AA), a self-help program based on 12 steps, is open to anyone whose goal is sobriety. The first step requires that the individual admit that he is powerless over alcohol and needs helpMembers are in various stages of recovery , and the individual does not have to be sober for at least a month before joining. Potential members are not interviewed. The individual decides how many meetings to attend each week. AA does not require attendance at meetings daily, but some individuals choose to do so, especially at the beginning of recovery.

59. A client is to be discharged from an alcohol rehabilitation program. Which of the following should the nurse emphasize in the discharge plan as a priority? 1. Supportive friends. 2. A list of goals. 3. Family forgiveness. Follow-up care.

59. 4. Follow-up care is essential to prevent relapse. Recovery has just begun when the treatment program ends. The first few months after program completion can be difficult and dangerous for the chemically dependent client. The nurse is responsible for discharge plans that include arrangements for counseling, self-help group meetings, and other forms of aftercare. Supportive friends, a list of goals, and family forgiveness may be important and helpful to the client, but follow-up care is essential.

6. A client is complaining to other clients about not being allowed by staff to keep food in her room. The nurse should: 1. Ignore the client's behavior. Set limits on the behavior. 3. Reprimand the client. 4. Allow the snack to be kept in her room.

6. 2. The nurse needs to set limits on the client's manipulative behavior to help the client control dysfunctional behavior. The manipulative client bends rules to have her needs met without regard for rules or the needs or rights of others. A consistent approach by the staff is necessary to decrease manipulation. Ignoring the client's behavior reinforces or promotes the continuation of the client's manipulative behavior. Reprimanding the client may be perceived as a threat, resulting in aggressive behavior. Allowing the client to keep a snack in her room reinforces the dysfunctional behavior.

60. The client is to be discharged from the hospital after a safe, medically supervised withdrawal from alcohol. Which of the following outcomes indicate client readiness for an outpatient alcohol treatment program? Select all that apply. 1. The client states the need to cut down on his alcohol intake. The client verbalizes the damaging effects of alcohol on his body. The client plans to attend Alcoholics Anonymous meetings. The client takes naltrexone (ReVia) daily. 5. The client says he is indestructible.

60. 2, 3, 4. The client who plans to attend Alcoholics Anonymous meetings, verbalizes the damaging effects of alcohol on his body, and takes naltrexone daily may be ready for alcohol rehabilitation. Other key outcomes include admitting that a problem with alcohol exists and realizing the negative effects of alcohol on his life. Stating that he needs to cut down on his alcohol intake and that he is indestructible are signs of denial of an alcohol problem.

61. A client diagnosed with major depression and substance dependence is being admitted to the Dual Diagnosis Unit. In explaining the focus of this program, the nurse should tell the client? 1. The addiction will be treated first, then the depression. 2. The depression with be treated first, then the addiction. There will be simultaneous treatment of the addiction and depression. 4. As the addiction is treated, the depression will clear up on its own.

61. 3. The best approach is to treat both illnesses simultaneously. Treating one and not the other is ineffective . The depression will not clear just by becoming sober or clean.

62. While caring for a client who has a dual diagnosis of bipolar disorder and alcohol dependency, which of the following areas is the priority for daily assessment? 1. Sleep pattern. Mental status. 3. Eating habits. 4. Self-care ability.

62. 2. The nurse should assess the client's mental status daily to note changes that could occur from exacerbation of the mental illness or withdrawal from alcohol. Changes in mental status are important for treatment issues such as medication and participation in groups. Assessment of mental status takes priority because mental status affects the client's ability to sleep, eat, and care for himself. Flexibility is necessary on the part of nurses and staff members who are working with a heterogeneous client population.

63. A client diagnosed with schizophrenia and alcohol abuse decides to drink alcohol with his buddies . The nurse recognizes which of the following as the underlying dynamic of the client's alcohol use? The decision to use alcohol is a wish to feelaccepted by others. 2. The decision to drink increases the client's guilt and shame. 3. The client abused alcohol before developing a mental illness. 4. The client is compelled to drink because of cognitive difficulties.

63. 1. The client's decision to drink results in feeling accepted by his peers which increases his self-esteem. Guilt or shame may result later because the client is aware that he should not use alcohol because of his mental illness. The combination of a mental illness and substance abuse results in increased recidivism and treatment complications. It may not be true that the client abused alcohol before developing a mental illness or that the client is compelled to drink because of cognitive difficulties. The client may be predisposed to developing a substance abuse problem and a mental illness because of heredity and biologic factors.

65. A school nurse is planning a program for parents on "Drugs Commonly Abused by Teenagers." Which of the following information should be included about inhalants? Select all that apply. Monitor for paper bags and rags that may have been used for breathing inhalants. 2. Brain damage is unlikely with the use of inhalants. 3. Use of inhalants by teens is on the decline. Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit. Inhalants usually cause depression of the central nervous system. The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol propellants from spray cans, and anesthetics/ gases.

65. 1, 4, 5, 6. The nurse should instruct the parents to monitor their children for use of paper bags or rags. The nurse should present information about brain damage from inhalants including damage to the frontal lobe, cerebellum, and hippocampus, and that death is possible. Rather than use being on the decline, teenagers are experimenting even more with many types of inhalants, such as Freon, ground-up candy disks, and spray cleaners for computer and TV screens.

66. The friend of a client brought to the emergency department states, "I guess she had some bad junk (heroin) today." The client is drowsy and verbally nonresponsive. Which of the following assessment findings is of immediate concern to the nurse? Respiratory rate of 9 breaths/ min. 2. Urinary retention. 3. Hypotension. 4. Reduced pupil size.

66. 1. A respiratory rate of less than 12 breaths/ min is cause for concern because of central nervous system depression.Respiratory depression and arrest is the primary cause of death among clients who abuse opioids. Peripheral nervous system effects associated with opioid abuse include urinary retention, hypotension, reduced pupil size, constipation, and decreased gastric, biliary, and pancreatic secretions. Pinpoint pupils are a sign of opioid overdose . However, respiratory depression is the immediate concern.

67. A client is brought to the emergency department by a friend who states, "He wasusing a lot of heroin until he ran out of money about 2 days ago." The nurse judges the client to be in opioid withdrawal if he exhibits which of the following? Select all that apply. Rhinorrhea. Diaphoresis. Piloerection. 4. Synesthesia. 5. Formication.

67. 1, 2, 3. Symptoms of opioid withdrawal include yawning, rhinorrhea, sweating, chills, piloerection (goose bumps), tremors, restlessness, irritability, leg spasms, bone pain, diarrhea, and vomiting. Symptoms of withdrawal occur within 36 to 72 hours of usage and subside within a week. Withdrawal from heroin is seldom fatal and usually does not necessitate medical intervention. Synesthesia (a blending of senses) is associated with lysergic acid diethylamide use, and formication (feeling of bugs crawling beneath the skin) is associated with cocaine use.

68. An unconscious client in the emergency department is given IV naloxone (Narcan) due to an overdose of heroin. Which of the following would indicate a therapeutic response to the Narcan? Select all that apply. 1. Decreased pulse rate. 2. Warm skin. 3. Dilated pupils. Increased respirations. Consciousness.

68. 4, 5. Naloxone is an opioid antagonist used to treat an opioid overdose. Within a few minutes, the client should have an increase of respirations to near normal and become conscious. With a heroin overdose , the pulse is not significantly affected, the skin becomes warm and wet, and the pupils aredilated. With naloxone the skin would return to a normal temperature and become dry . The pupils also would react normally and the pulse would not be decreased.

69. Which of the following should the nurse expect to assess for a client who is exhibiting late signs of heroin withdrawal? Vomiting and diarrhea. 2. Yawning and diaphoresis. 3. Lacrimation and rhinorrhea. 4. Restlessness and irritability.

69. 1. Vomiting and diarrhea are usually late signs of heroin withdrawal , along with muscle spasm, fever, nausea, repetitive sneezing, abdominal cramps, and backache. Early signs of heroin withdrawal include yawning, tearing (lacrimation), rhinorrhea, and sweating . Intermediate signs of heroin withdrawal are flushing, piloerection, tachycardia, tremor, restlessness, and irritability.

7. A client with an Axis II diagnosis ofantisocial personality disorder has a potential for violence and aggressive behavior. Which of the following client outcomes to be accomplished in the short term is most appropriate for the nurse to include in the plan of care? 1. Use humor when expressing anger. Discuss feelings of anger with staff. 3. Ask the nurse for medication when upset. 4. Use indirect behaviors to express anger.

7. 2. The nurse assists the client with identifying and putting feelings into words during one-to-one interactions. This helps the client express her feelings in a nonthreatening setting and avoid directing anger toward other clients . A client with an antisocial personality disorder needs to understand how others feel and react to her behaviors and why they react the way they do. The client also needs to understand theconsequences of her behaviors. Using humor or indirect behaviors to express anger is a passive- aggressive method that will not help the client learn how to express her anger appropriately. Asking the nurse for medication when upset is a way to avoid dealing with feelings and is not helpful . However, medication may be necessary if talking and engaging in a physical activity have not been effective in lowering anxiety or if the client is about to lose control of her behavior.

70. After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? 1. Cerebral edema. 2. Kidney failure. 3. Seizure activity. Respiratory depression.

70. 4. After administering naloxone, the nurse should monitor the client's respiratory status carefully because the drug is short acting and respiratory depression may recur after its effects wear off. Cerebral edema , kidney failure, and seizure activity are not directly related to opioid overdose or naloxone therapy.

71. When teaching a client who is to receive methadone therapy for opioid addiction, the nurse should instruct the client that methadone is useful primarily for which of the following reasons? 1. It is not an addictive substance. 2. A maintenance dose is taken twice a day. 3. The client will no longer be addicted to opioids. The client may work and live normally.

71. 4. The client takes methadone primarily to be able to work, live normally , and function productively without the mental and physical deterioration caused by opioid addiction. Methadone lessens physiologic dependence on opioids and is used to preventwithdrawal symptoms. Methadone, a substance similar to morphine, is an addictive substance; the client is still considered addicted to opioids. Because methadone has a long half-life of 15 to 30 hours, it can be taken once a day on an outpatient basis.

72. A client states to the nurse, "I'm not going to any more Narcotics Anonymous meetings. I felt out of place there." Which of the following responses by the nurse is best? " Try attending a meeting at a different location; you may feel more comfortable there." 2. "Maybe it just wasn't a good day for you. Everybody has bad days now and then." 3. "Perhaps you weren't paying close enough attention to what they were saying." 4. "Sometimes the meetings can seem like a waste of time, but you need to attend to stay clean."

72. 1. Suggesting that the client try attending a meeting at a different location is a supportive, positive response and encourages the client to continue participating in treatment. Saying, "Maybe it just wasn't a good day for you," or "Perhaps you weren't paying close enough attention ," places blame on the client and is not helpful. The statement , "Sometimes the meetings can seem like a waste of time, but you need to attend to stay clean," diminishes the importance of the self -help group and offers little support to the client.

73. Which of the following should the nurse use as the best measure to determine a client's progress in rehabilitation? 1. The kinds of friends he makes. The number of drug-free days he has . 3. The way he gets along with his parents. 4. The amount of responsibility his job

73. 2. The best measure to determine a client's progress in rehabilitation is the number of drug-free days he has. The longer the client abstains, the better the prognosis is. Although the kinds of friends the client makes, the way he gets along with his parents, and the degree of responsibility his job requires could influence his decision to stay clean, the number of drug-free days is the best indicator of progress.

74. Which of the following should lead the nurse to suspect that a client is addicted to heroin? 1. Hilarity. 2. Aggression. 3. Labile mood. Hypoactivity.

74. 4. The client who is addicted to heroin is most likely to exhibit hypoactivity. Initially, the client feels euphoric. This is followed by drowsiness, hypoactivity, anorexia, and a decreased sex drive. Hilarity, aggression, and a labile mood usually are not associated with heroin addiction.

75. A client brought by ambulance to the emergency department after taking an overdose of barbiturates is comatose. The nurse should assess the client for: 1. Kidney failure. 2. Cerebrovascular accident. 3. Status epilepticus. Respiratory failure.

75. 4. Because barbiturates are central nervous system depressants, the nurse should be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate overdose. Kidney failure, cerebrovascular accident, and status epilepticus are not associated with barbiturate overdose.

76. The client's friend reports that the client has been taking about eight "reds" (800 mg of secobarbital [Seconal]) daily, besides drinking more alcohol than usual . The client's friend asks anxiously, "Do you think she will live?" Which of the following responses by the nurse is most appropriate? 1. "We can only wait and see. It's too soon to tell." 2. "Do you know her well? She's so young." 3. "She is very ill and may not live. Some don't pull through." "Her condition is serious. You sound very worried about her."

76. 4. When a friend asks whether a seriously ill client will live, it is best for the nurse to respond by explaining the seriousness of the client's condition and acknowledging the friend's concern. This type of comment does not offer false hope. Telling the friend to wait and see and that it is too soon to tell is a stereotypical statement that offers no support to the friend. Asking the friend to describe his or her relationship with the client ignores the friend's concern and does not focus on the problem. Simply saying that the client is very ill and may not live and that some don't pull through is harsh and not supportive.

77. Before his hospitalization, a client needed increasingly larger doses of barbiturates to achieve the same euphoric effect he initially realized from their use . From this information, the nurse develops aplan of care that takes into account that the client is likely suffering from which of the following? Tolerance. 2. Addiction. 3. Abuse. 4. Dependence.

77. 1. Tolerance for a drug occurs when a client requires increasingly larger doses to obtain the desired effect. Therefore, the plan of care would address the client's state of tolerance. The term addiction refers to psychological and physiologic symptoms indicating that an individual cannot control his or her use of psychoactive substances . This term has been replaced with the term dependence. Abuse refers to the excessive use of a substance that differs from societal norms. Drug dependence occurs when the client must take a usual or increasing amount of the drug to prevent the onset of abstinence symptoms, cannot keep drug intake under control, and continues to use even though physical, social, and emotional processes are compromised.

78. Which of the following statements by the nurse is most appropriate when addressing a client with a barbiturate overdose who awakens in a confused state and exhibits stable vital signs? 1. "I'm here to help you beat your drug habit. But it's you who will need to work hard." 2. "It's time to get straight and stay clean and put an end to your torture." 3. "I'm glad you pulled through; it was touch and go with you for a while." "You're in the hospital because of a drug problem; I'm one of the nurses who will help you."

78. 4. For a client who is confused when awakening after taking a large dose of barbiturates, the nurse should speak in concrete terms using simple statements in a calm, nonjudgmental, gentle manner to assist the client with cognitive-perceptual impairment, enhance understanding, and decrease anxiety. The other statements contain abstract information and some slang terms that may further confuse the client and thus increase the client's anxiety.

79. A client states that her "life has gone down the tubes" since her divorce 6 months ago. Then, after she lost her job and apartment, she took an overdose of barbiturates so she "could go to sleep and never wake up." Which of the following statements by the nurse should be made first? 1. "It seems as if your self -esteem has been affected by all your losses." "I know you took an overdose of barbiturates. Are you thinking of suicide now?"

79. 2. The highest priority is assessing for suicide risk. When the client is safe, then the self-esteem, helplessness, and hopelessness issues can be addressed.

8. A new client on the psychiatric unit has been diagnosed with depression and obsessive-compulsive personality disorder (OCPD). During visiting hours, her husband states to the nurse that he doesn't understand this OCPD and what can be done about it. What information should the nurse share with the client and her husband? Select all that apply. Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time. 2. It will help to interrupt her tasks and tell her you are going out for the evening. There are medicines, such as clomipramine (Anafranil) or fluoxetine (Prozac) that may help. Remind your wife that it is "OK" to be human and make mistakes. 5. Reinforce with her that she is not allowed to expect the whole family to be perfect too. This disorder typically involves inflexibility

8. 1, 3, 4, 6. Inflexibility, need to be in control, perfectionism, overemphasis on work or tasks, and a fear of making mistakes are common symptoms of OCPD. Anafranil and Prozac may help with the obsessive symptoms, Interrupting the client's tasks is likely to increase her anxiety even more. Telling her that she cannot expect the family to be perfect is likely to create a power struggle.

80. A client who has experienced the loss of her husband through divorce, the loss of her job and apartment , and the development of drug dependency is suffering situational low self-esteem. Which of the following outcomes is most appropriate initially? The client will discuss her feelings related to her losses. 2. The client will identify two positive qualities. 3. The client will explore her strengths. 4. The client will prioritize problems.

80. 1. The most appropriate initial outcome for the client is to discuss thoughts and feelings related to her losses. The nurse should help the client identify and verbalize her feelings so that she can externalize her thoughts and emotions and begin to deal with them. This prevents the client from internalizing feelings, which leads to depression and self-harm. The ability to identify two positive qualities, explore strengths, and prioritize problems would be appropriate after the client has explored her thoughts and feelings, gained awareness of the issues, and then can participate in the treatment plan.

81. The nurse notices that a client recovering from a barbiturate overdose spends most of his time with other young adults who have substance-related problems. This group of clients is a dominant force on the unit, keeping the nondrug users entertained with stories of their "highs." Which of the following methods is best to use when dealing with this problem? 1. Providing additional recreation. 2. Breaking up drug-oriented discussions. 3. Speaking with the clients individually about their behavior. Discussing the behavior at the daily community meeting.

81. 4. The best method to deal with the problem is to discuss observations with clients at the daily community meeting because the problem involves all of the clients and this provides them with the opportunity to offer their views. Peer pressure is valuable in confronting self -defeating and destructive behaviors. Providing additional recreation avoids or ignores the problem and is damaging to all clients because it decreases trust in the nurse . Breaking up drug-oriented discussions wouldnot be sufficient to stop the behavior . Speaking with the clients individually about their behavior is not as effective as dealing with the problem openly and directly with everyone.

82. A client recovering from a drug overdose is interacting with the nurse and recounting her exploits at numerous partiesshe's attended. Which of the following actions is most therapeutic? 1. Allowing the client to continue with her stories. 2. Telling the client you've heard the stories before. 3. Questioning the client further about her exploits. Directing the conversation to realistic concerns.

82. 4. The nurse directs the conversation to realistic concerns or issues to decrease denial and focus on rebuilding a substance-free life. Allowing the client to continue with the stories or questioning the client further about her exploits reinforces the denial. Telling the client you've heard the stories before is nondirective. Additionally, these actions do nothing to help the client focus on rebuilding a substance-free life. CN: Psychosocial integrity;

83. The nurse is speaking to a sixth grade class about drugs. A student states, "I know someone who smokes marijuana and he says it's safe." The nurse should tell the student: 1. "Marijuana isn't safe, and it is illegal." 2. "Do you really believe him?" "That drug causes more damage to your body than regular cigarettes." 4. "Marijuana usage can lead to using other chemicals."

83. 3. The statement that marijuana causes more damage to your body than regular cigarettes is a direct, correct , educational response to the student's statement that does not decrease the student's or the friend's self-worth. Marijuana causes harmful pulmonary effects, weakens heart contractions, causes immunosuppression, and reduces serum testosterone and sperm count. Telling the student that marijuana is unsafe and illegal, or that using marijuana leads to using other chemicals, does not provide the student with factual information to answer the student's question. Asking whether the student really believes the friend challenges the student andmay lead to defensive behavior.

84. When developing a teaching plan for a group of middle school children about the drug 3,4-methylenedioxymethamphetamine (Ecstasy), what information should the nurse expect to include? Select all that apply. Using Ecstasy is similar to using speed. Ecstasy is used at all-night parties. 3. Teeth grinding is seen with cocaine, not Ecstasy use. It can cause death. It reduces self-consciousness.

84. 1, 2, 4, 5. Ecstasy is chemically related to methamphetamine (speed) and is used at all-night parties also known as "raves" to enhance dancing, closeness to others, affection, and the ability to communicate. Euphoria, heightened sexuality, disinhibition, and diminished self-consciousness can occur. Adverse effects include tachycardia, elevated blood pressure, anorexia, dry mouth, and teeth grinding. Pacifiers, including candy-shaped pacifiers and lollipops, are used to ease the discomfort associated with teeth grinding and jaw clenching. Hyperthermia, dehydration, renal failure, and death can occur.

85. A young client is being admitted to the psychiatric unit after her obstetrician's staff suspected she was experiencing a postpartum psychosis. Her husband said shewas doing fine for 2 weeks after the birth of the baby, except for pain from the C-section and trouble sleeping. These symptoms subsided over the next 4 weeks. Then 3 days ago, the client started having anxiety, irritability, vomiting, diarrhea, and delirium, resulting in her inability to care for the baby. Then the husband says, "I saw that my bottles of alprazolam and oxycodone were empty even though I haven't been taking them." In what order of priority from first to last should the nurse do the following? 1. Call the physician for prescriptions for appropriate treatment for opiate and benzodiazepine withdrawal. 2. Immediately place the client on withdrawal precautions. 3. Confirm with the client that she has in fact been using her husband's medications. 4. Assess the client for prior and current use of any other substances.

85. 3. Confirm with the client that she has in fact been using her husband's medications. 4. Assess the client for prior and current use of any other substances. 2. Immediately place the client on withdrawal precautions. 1. Call the physician for prescriptions for appropriate treatment for opiate and benzodiazepine withdrawal. It crucial to confirm that the client was taking her husband's opiates andbenzodiazepines and that her symptoms are due to the sudden withdrawal from these medications. It is also important to know if she has been using other substances (such as alcohol) that may cause other withdrawal symptoms. Even before calling the physician for prescriptions, the nurse can initiate withdrawal precautions for client safety.

86. A 68-year-old client is admitted to the addiction unit after treatment in the Emergency Department for an overdose of Percocet (oxycontin). Her son calls the unit and expresses intense anger that his motheris being treated as a "common street addict." He says she has severe back pain and was given that prescription by her doctor. "She just accidentally took a few too many pills last night." Which reply by the nurse is most therapeutic? 1. "I understand that your mother may not have intentionally taken too many pills. This medication can cause one to forget how many have been taken." 2. "It may be appropriate for your mother to be referred to a pain management program." 3. "Unfortunately, it is fairly common for clients with pain to increase their use of pain pills over time." "I can hear how upset you are. You sound very concerned about your mother."

86. 4. Acknowledging the client's son's feelings is the most therapeutic intervention because he is not likely to hear the nurse's information until his anger and other feelings are addressed and subside. Then it is important to acknowledge that oxycontin, especially in older clients, can interfere with remembering how many pills were taken. It is common for clients with chronic pain to inadvertently overuse or become addicted to pain medications. Pain management programs help clients to withdraw from the offending medication and start on a multifaceted system for controlling the pain.

87. A client is being admitted to the addictions unit for a confirmed and long-term addiction to Xanax (alprazolam). She continues to strongly deny her addiction , stating she was prescribed the Xanax to control her "panic attacks." Which of the following procedures would be the most important during the admission process? Select all that apply. Assess the client for suicide, escape, and aggression risks. With the client present, search the client's clothes and belongings for contraband and restricted items. Initiate withdrawal precautions. 4. Explain the unit routine and types of groups. Obtain a urine specimen for a urine drug screen.

87. 1, 2, 3, 5. Clients who deny an addiction and the need for treatment can be at risk for a suicide attempt, efforts to escape the unit, and aggression directed at staff. A contraband search is a safety measure to look for concealed drugs and dangerous items . Depending on the last use of the substance, withdrawal symptoms can begin quickly. A urine drug screen is crucial to determine what other substances the client may beusing that may cause other withdrawal symptoms. Explaining the unit routines and groups can wait until the client is calmer and more receptive. CN: Safety

88. A client is returning to the primary care physician's office for follow-up on his diagnosis of coronary artery disease. After all the appropriate exams and assessments are completed, the nurse asks the client about how well he is sleeping . The client states , "Oh, that's not a problem anymore. I take a couple of my wife's Valiums (diazepam) and sleep like a baby." Which of the following information should the nurse obtain? Select all that apply. 1. The reason the client's wife is taking Valium. The dose of the Valium he is taking and how long he has been taking it. Exactly how many Valiums he takes at night and during the day, 4. Whether he intends to stop the Valium use. What was interfering with his sleep prior to starting the Valium.

88. 2, 3, 5. The dose, length of use, and the number of Valiums taken per day are important for assessing the severity of the substance abuse and potential withdrawal. Determining sleep interferences is necessary for treating the underlying causes of the insomnia. The reason his wife takes Valium is confidential information and not critical to his situation. Getting off the Valium is essential, not an option, especially with his cardiac issues. This needs to be done safely if he has been taking it for more than a week or 2.

89. A client who chronically snorts cocaine is brought to the emergency department due to a cocaine overdose. The client is experiencing delusions, hallucinations, mild respiratory distress, and mild tachycardia initially. The nurse should do which of the following? Select all that apply. 1. Induce vomiting. Place seizure pads on the bed. Administer PRN haloperidol (Haldol) as prescribed. Monitor for respiratory acidosis. Encourage deep breathing. Monitor for metabolic acidosis.

89. 2, 3, 4, 5, 6. The cocaine was not swallowed, so inducing vomiting is not indicated. A cocaine overdose can produce seizures, paranoia, and respiratory and/ or metabolic acidosis. Deep breathing will help decrease the respiratory distress and pulse rate. CN:

9. A client diagnosed with paranoid personality disorder is being admitted on an Immediate Detention Order (24-hour hold) after a physical altercation with a police officer who was investigating the client's threatening phone calls to his neighbors. He states that his neighbors are spying on him for the government. "I want them to stop and leave me alone. Now they have you nurses and doctors involved in their conspiracy ." Which of the following nursing approaches are most appropriate? Select all that apply. Approach the client in a professional , matter-of-fact manner. Avoid intrusiveness in interactions with the client. 3. Gently present reality to counteract the client's current paranoid beliefs . Develop trust consistently with the client. Do not pressure the client to attend any groups.

9. 1, 2, 4, 5. A professional, matter-of-fact approach and developing trust are the most effective with this client. A friendly approach, intrusiveness, and attempting to counteract the client's beliefs will increase the client's paranoia; he will present more false beliefs to prove he is right about the conspiracy. In groups, questions from peers, confrontations with reality, and the emotionality

90. A client walks into the clinic and tells the nurse she has run out of money for crack , has crashed, and wants something to help her feel better. Which of the following is most important for the nurse to assess? 1. Suspiciousness. 2. Loss of appetite. 3. Drug craving. Suicidal ideation.

90. 4. The nurse assesses the client for feelings of depression and suicidal ideation . After experiencing an instantaneous high from crack, a crash immediately follows andthe client has an intense craving for more crack. A crash commonly leads to a cocaine -induced depression when additional crack is unavailable. At times, the depression is so severe that users attempt suicide. Although suspiciousness, loss of appetite, and drug craving are also associated with cocaine use , they are less of a priority than suicidal ideation.

91. A client in the emergency department is diagnosed as having amphetamine psychosis. The nurse should take all of the following actions in which order of priority from first to last? 1. Transfer the client to the psychiatric unit. 2. Monitor cardiac and respiratory status. 3. Place seizure pads on the bed. 4. Administer IM haloperidol (Haldol) as prescribed.

91. 3. Place seizure pads on the bed. 2. Monitor cardiac and respiratory status. 4. Administer IM haloperidol (Haldol) as prescribed. 1. Transfer the client to the psychiatric unit. The risk of seizures is an immediate safety issue, and the nurse should first place seizure pads on the bed. Amphetamine overdose can produce cardiac arrhythmias and respiratory collapse; the nurse should next monitor the client. Then the Haldol is indicated to antagonize the amphetamine affects. When the client is medically stable, the nurse can transfer the client to a psychiatric unit . Haldol would be stopped as the psychotic symptoms subside.

92. A client has been taking increased amounts of alprazolam (Xanax) for about 6 months for anxiety. She asks the nurse how she can "get off the Xanax." The mostaccurate answer by the nurse is which of the following? 1. "There will be an immediate discontinuation of the Xanax and haloperidol (Haldol) will be available if needed." "Instead of Xanax, you will take lorazepam (Ativan) in decreasing doses and frequency over a period of 3 to 4 days." 3. "The Xanax will be tapered down over a period of 48 hours." 4. "Xanax will be available on an as-needed basis for 4 to 5 days."

92. 2. Ativan, as opposed to Xanax, is available in dosage ranges that allow moregradual tapering down of doses over the 3 to 4 days. Haldol is not effective for benzodiazepine withdrawal. Tapering Xanax in 48 hours is too rapid. Offering Xanax as a PRN does not deal with the need to gradually reduce the dose and frequency over time.

93. The client is fidgeting and has trouble sitting still . He has difficulty concentrating and is tangential. Which of the following interventions should help decrease this client's level of anxiety? Select all that apply. Refocusing attention. Allowing ventilation. 3. Suggesting a time-out. 4. Giving intramuscular medication. Assisting with problem solving.

93. 1, 2, 5. The client is exhibiting symptoms of moderate anxiety. At this level of anxiety, the nurse should help the client to decrease anxiety by allowing ventilation, crying, exercise, and relaxation techniques. The nurse would further assist the client by refocusing his attention, relating behaviors and feelings to anxiety, and then assisting with problem solving. Oral medication may be needed if the client's anxiety is prolonged or does not decrease with the nurse's interventions. Suggesting a time-out and giving intramuscular medication are possible interventions for a client whose anxiety level is severe.

94. When caring for a client who has overdosed on phencyclidine (PCP), the nurse should be especially cautious about which of the following client behaviors? 1. Visual hallucinations. Violent behavior. 3. Bizarre behavior. 4. Loud screaming.

94. 2. The nurse must be especially cautious when providing care to a client who has taken phencyclidine (PCP) because of unpredictable, violent behavior. The client can appear to be in a calm state or even in a coma, then become violent, and then return to a calm or comatose state. Visual hallucinations, bizarre behavior, and loud screaming are associated with PCP-intoxicated clients. However, theunpredictable, violent behavior presents a major issue of safety for clients and staff.

95. Which of the following liquids should the nurse administer to a client who is intoxicated on phencyclidine (PCP) to hasten excretion of the chemical? 1. Water. 2. Milk. Cranberry juice. 4. Grape juice.

95. 3. An acid environment aids in the excretion of PCP. Therefore, the nurse should give the client with PCP intoxication cranberry juice to acidify the urine to a pH of 5.5 and accelerate excretion.

96. When assessing a client with possible alcohol poisoning, the nurse should investigate the client's use of which of the following substances while drinking alcohol? Marijuana. 2. Lysergic acid diethylamide. 3. Peyote. 4. Psilocybin.

96. 1. Smoking marijuana while using alcohol can lead to alcohol poisoning because marijuana masks the nausea and vomiting associated with excessive alcohol consumption. Marijuana contains tetrahydrocannabinol (THC), which is responsible for suppressing nausea. With dangerous levels of alcohol in the body , respiratory depression , coma, and death can occur. Lysergic acid diethylamide, peyote, and psilocybin do not contain THC.

97. A client with a cocaine dependency is irritable, anxious, highly sensitive to stimuli , and overreactive to clients and staff on the unit. Which of the following actions is most therapeutic for this client? 1. Secluding and restraining the client as needed. 2. Telling the client to stay in his room until he can control himself. Providing the client with frequent "time -outs." 4. Confronting the client about his behaviors.

97. 3. Providing frequent "time -outs" when the client is highly anxious, sensitive, irritable, and over-reactive is needed to calm the client and reduce the possibility of escalating behaviors and violence. Secluding and restraining the client is not appropriate and would only be used if the client was threatening others and other alternative actions had been unsuccessful. Telling the client to stay in his room until he can control himself is unrealistic and futile because the client cannot eliminate behaviors induced by chemicals . Confronting the client about his behaviors would most likely lead to aggression and possibly violent behavior.

98. A client with symptoms of amphetamine psychosis that are improving is anxious and still experiencing some delusions. When developing the client's plan of care, which of the following measures should the nurse include? 1. Assign the client to a group meeting about the physiologic effects of drugs. 2. Advise the client to watch television. 3. Wait for the client to approach thenurse. Invite the client to play a game of ping-pong with the nurse.

98. 4. The nurse should invite the client who is anxious to participate in an activity that involves gross motor movements. Doing so helps to direct energy toward a therapeutic activity. Appropriate activities include walking, riding a stationary bicycle, or playing volleyball. Assigning the client to an educational group is not helpful because the anxious client would be unable to sit in a group setting and concentrate on what was occurring in the group. Watching television may be too stimulating for the client, possibly increasing anxiety. Additionally, the client may be too anxious to sit and focus. Waiting for the client to approach the nurse is not helpful or appropriate. The nurse is responsible for initiating contact with the client.

99. 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 don't think I need methadone any more." It is important to discuss which of the following pieces of information with this client? Select all that apply. "Detoxification will likely occur with slowly decreasing doses of methadone." 2. "Oxycodone will be available if needed for break-through-pain.""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 nonnarcotic pain medicines."

99. 1, 3, 4, 5. Since methadone is an addictive medication, the client will be gradually tapered off of it, while monitoring him for withdrawal symptoms. Any residual pain is likely to be controlled with other pain management techniques and nonnarcotic pain medication. It is very unlikely that oxycodone would be prescribed PRN since it is a very addictive medication.

64. A client is being 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 of the following responses by the nurse is most appropriate? 1. "Once you are tapered off the oxycodone, you will find that nonaddictive pain medicines will be enough to control your pain." 2. "You are going to be switched from the oxycodone to methadone for long-term pain management. 3. The oxycodone will be stopped tomorrow, but you will have lorazepam to help you with the withdrawal symptoms. Your pain will be controlled by tapering doses of oxycodone, with other pain management strategies and medicines.

The Client with Disorders Related to Other Addictive Substances 64. 4. Tapering doses of oxycodone, pain management strategies, and other pain control medicines are found to be the most helpful with opiate addictions resulting from chronic pain. Nonaddictive (over-the-counter) medicines alone are generally insufficient for chronic pain management. Methadone is an addictive opioid that involves substituting one addiction with another, so now clients are being detoxed off Methadone as well. Lorazepam may help with anxiety during withdrawal from opiates , but it does not control the other symptoms of opiate withdrawal.

26. A client has been diagnosed with dementia related to chronic and heavy alcohol consumption. In a family meeting with the client, discharge plans are being discussed. Which of the following points should the nurse share with the family and client? Select all that apply. 1. The house and garage need to be searched and all the alcohol products destroyed. 2. Without continued alcohol intake, the client will gradually get better. 3. With the memory loss, answer the client's question once, and then ignore that question when asked again. Safety alarms on the doors will help to keep the client from wandering off. As the need for supervision increases, it may be necessary for the client to be placed in an extended care facility.

The Client with an Alcohol-Related Disorder 26. 4, 5. As with any dementia, there is a need to protect the client from wandering off and risking harm to self. Dementia is progressive and eventually requires 24-hour supervision. Destroying the alcohol is notably ineffective; the client will find a way to get more if quitting is not a personal goal. Not answering the client's question will generally increase the client's anger. Once the dementia is evident, lack of alcohol intake will not reverse the condition.