Psychiatric Nursing - Substance Abuse, Eating Disorders, Impulse Control Disorders

A client with a history of heroin addiction is admitted to the hospital intensive care unit with a diagnosis of opioid drug overdose. While talking with a nurse, the client's parent reports a plan to have his child declared legally incompetent. Which response by the nurse is most therapeutic? "Your child is ill and can't make decisions about health care and safety right now, but this situation is temporary." "You don't have the right to declare your child incompetent. Your child has rights, too." "I'll help you contact the hospital legal representative for help with the paperwork." "If you become the guardian, you'll be responsible for your child's finances and paying for treatment."

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

A client is being treated for alcoholism. After a family meeting, the client's spouse asks a nurse about ways to help the family deal with the effects of the spouse's alcoholism. The nurse should suggest that the family join which organization? Al-Anon Make Today Count Emotions Anonymous Alcoholics Anonymous

Al-Anon

A client who lives with his spouse and two adolescent children is being treated for alcoholism. After a family meeting, the client's wife asks a nurse about ways to help the family deal with the effects of her husband's alcoholism. Which organizations should the nurse suggest that the family join? Select all that apply. Al-Anon Make Today Count Emotions Anonymous Alcoholics Anonymous Alateen

Al-Anon Alateen

A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug? Disulfiram decreases the need for alcohol. Disulfiram acts to deter alcohol consumption. Disulfiram improves the alcoholic's ability to drink limited amounts of alcohol. Disulfiram creates a nerve block so that the effects of alcohol are not felt.

Disulfiram acts to deter alcohol consumption.

A nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan? Restrict visits with family members until the client begins to eat. Provide privacy for the client during meals. Set up a strict eating plan with the client. Encourage the client to exercise, to reduce anxiety.

Set up a strict eating plan with the client.

Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect: a postoperative infection. alcohol withdrawal. septicemia. alcohol hallucinosis.

alcohol withdrawal.

A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should: check the client frequently at irregular intervals. assure the client that the nurse will hold in confidence anything the client says. repeatedly discuss the client's previous suicide attempts. disregard decreased communication by the client because decreased communication is typical of suicidal clients.

check the client frequently at irregular intervals.

A nurse is administering total parenteral nutrition (TPN) to a client hospitalized with severe anorexia nervosa. Which laboratory finding would alert the nurse to a potential problem? elevated glucose levels decreased magnesium level elevated phosphate level decreased CD4 cell counts

decreased magnesium level

A severely dehydrated adolescent admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the past month. She is 5′ 7″ (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority? initiating caloric and nutritional therapy as ordered instituting behavioral modification therapy as ordered addressing the client's low self-esteem monitoring vital signs and weight regularly

initiating caloric and nutritional therapy as ordered

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

lorazepam

When monitoring a client recently admitted for treatment of cocaine addiction, a nurse notes sudden increases in the arterial blood pressure and heart rate. Which medication should the nurse prepare to administer? lidocaine nifedipine nitroglycerin norepinephrine

nifedipine

A 68-year-old client is admitted to the addiction unit after treatment in the emergency department for an overdose of oxycodone. The client's adult child calls the unit and expresses intense anger that the client is being treated as a "common street addict." The caller says their parent has severe back pain and was given that prescription by the client's healthcare provider. "My parent just accidentally took a few too many pills last night." Which reply by the nurse is most therapeutic? "I understand that your parent may not have intentionally taken too many pills. This medication can cause one to forget how many have been taken." "It may be appropriate for your parent to be referred to a pain management program." "Unfortunately, it's 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 parent."

"I can hear how upset you are. You sound very concerned about your parent."

Which outcome criterion is appropriate for a child diagnosed with oppositional defiant disorder? The child will recognize responsibility for behaviors. The child will verbalize needs and assert rights. The child will ask the nurse's permission to sleep late. The child will establish self limits and boundaries.

The child will recognize responsibility for behaviors.

A female client who is hospitalized for an eating disorder weighs 15 lb (6.8 kg) less than the ideal body weight. Which goal is a priority for this client? The client attends all eating disorder support groups. The client eats bigger meals at breakfast. The client gains 1 lb (0.5 kg) per week. The client reports an improved self-image.

The client gains 1 lb (0.5 kg) per week.

A client is admitted to the emergency department with an elevated blood alcohol level. The authorities state he was driving on the wrong side of the road. He is transferred to the acute care unit where he awakens the next morning. His vital signs are stable, and he has a headache. What should the nurse do first when caring for this client? Work through personal feelings related to substance use/abuse. Be persistent with the client regarding the substance use. Help to make abstinence and sobriety worthwhile for the client. Suggest a treatment program within the client's home area.

Work through personal feelings related to substance use/abuse.

The nurse is talking with a client who was diagnosed with bulimia 3 months ago. The client needs more education about the illness if she makes which comments? Select all that apply. "I know that this illness is chronic and intermittent. I'll always have to control it." "If I start severely restricting my eating, I may be building up to a bingeing episode." "When I'm not bingeing and purging, I can skip that eating disorder support group." "I've made a real effort to be more social and involved in activities." "My depression is gone, so I don't need my antidepressant any longer."

"My depression is gone, so I don't need my antidepressant any longer." "When I'm not bingeing and purging, I can skip that eating disorder support group."

In developing a plan of care for a client who has had previous episodes of angry verbal outbursts, the nurse plans to take an educational approach to the problem. Arrange the following steps the nurse should take from first to last. All options must be used. Assist the client to recognize the early cues of anger. Identify alternate ways to express anger. Help the client identify triggers for anger. Practice with the client appropriate ways to express anger.

1. Help the client identify triggers for anger. 2. Assist the client to recognize the early cues of anger. 3. Identify alternate ways to express anger. 4. Practice with the client appropriate ways to express anger.

One of the goals for a client with anorexia nervosa is for the client to demonstrate increased individual coping by responding to stress in constructive ways. Which intervention will the nurse discuss with the client as the best way to work toward meeting the goal? engaging in an enjoyable cardiovascular exercise daily studying the practices of mindfulness and meditation keeping a personal journal and discussing it with the nurse connecting with family and friends through phone calls

keeping a personal journal and discussing it with the nurse

A nurse is caring for a client undergoing opiate withdrawal, which causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: barbiturates. amphetamines. methadone. benzodiazepines.

methadone

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. Which actions are most important for the nurse to perform at this time? Select all that apply. restrict the client's physical activities weigh the client daily after the evening meal monitor the client's vital signs encourage the client to keep an accurate recording of her food and fluid intake assess the client's serum albumin and electrolyte levels

monitor the client's vital signs encourage the client to keep an accurate recording of her food and fluid intake assess the client's serum albumin and electrolyte levels

A client with a history of polysubstance abuse is admitted to the facility. The client reports nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance? alcohol cannabis cocaine opioids

opioids

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 factor is most important for the nurse to assess? suspiciousness loss of appetite drug craving suicidal ideation

suicidal ideation

A hospitalized client craves a drink after withdrawing from alcohol. Which measure is the best way to help the client resist the urge to drink? a locked-door policy a routine search of visitors one-to-one supervision by the staff support from other alcoholic clients

support from other alcoholic clients

A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dL; 43.2 mmol/dL). The client later admits to drinking heavily for years. The client periodically reports tingling and numbness in the hands and feet. Which finding does the nurse expect based on these symptoms? acetate accumulation thiamine deficiency triglyceride level of 300 mg/dL (3.39 mmol/L) serum potassium level of 1.8 mEq/L (1.8 mmol/L)

thiamine deficiency

A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas for the client to stop doing so. During an interview with the nurse, which client statement most strongly supports a diagnosis of a substance use disorder? "I use drinking as a means for staying social with some friends." "I spend only half of my paycheck at the bar. My friends spend more!" "I just drink to relax after work because I have a very stressful job." "I have been arrested for drunk driving three times, but I never had an accident."

"I have been arrested for drunk driving three times, but I never had an accident."

A client on a stretcher in the emergency department begins to thrash around, slap the sheets, and yell, "Get these bugs off of me." The client is disoriented and has a blood pressure of 189/75 mm Hg and a pulse of 96 bpm. The friend who is with the client says, "My friend was drinking a lot 3 days ago and asked me for money to get more vodka, but I didn't have any." What should the nurse do in order of priority from first to last? All options must be used. Remind the client that they are in the hospital and the nurse is with them. Monitor vital signs every 15 minutes. Chart the client's response to the interventions. Administer haloperidol and lorazepam IM as prescribe. Implement constant observation. Obtain a prescription to place the client in restraints, if needed.

Remind the client that they are in the hospital and the nurse is with them. Implement constant observation. Administer haloperidol and lorazepam IM as prescribe. Monitor vital signs every 15 minutes. Obtain a prescription to place the client in restraints, if needed. Chart the client's response to the interventions.

A client admitted to the alcohol detoxification program asks the nurse if there is a medication to "stop me from wanting a drink so badly." The nurse should teach the client about: naltrexone. haloperidol. magnesium sulfate. chlordiazepoxide.

naltrexone

While admitting a client to the alcohol treatment program, the nurse asks the client how long she has been drinking, how much she has 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 factor? the severity of the disease the severity of withdrawal symptoms the possibility of alcoholic hallucinosis the occurrence of delirium tremens

the severity of withdrawal symptoms

A teenage client is admitted to the psychiatric unit with both bulimia nervosa and anorexia nervosa. Which initial interventions are appropriate for this client? Select all that apply. Assign a staff member to accompany the client when using the bathroom. Have the client keep a self-monitoring journal as a coping strategy. Weigh the client in same amount of clothing and facing away from scale at daily scheduled intervals. Inform the client that parenteral nutrition will be necessary if the client does not gain weight. Assign a staff member to sit with client during meals and for 1½ hours after meals. Provide liquid protein supplements when client is unable to eat meals.

Assign a staff member to accompany the client when using the bathroom. Assign a staff member to sit with client during meals and for 1½ hours after meals. Weigh the client in same amount of clothing and facing away from scale at daily scheduled intervals. Have the client keep a self-monitoring journal as a coping strategy. Provide liquid protein supplements when client is unable to eat meals.