Substance Abuse, Eating Disorders, Impulse Control Disorders
The client in an alcohol treatment program asks the nurse, "Why do we need to talk about relapse? I know I'll never drink again." Which response by the nurse is best? 1) "Anyone can slip. Relapse commonly occurs during the first few months after a treatment program." 2) "Relapse prevention is important in follow-up care." 3) "It's important to talk about relapse prevention because your recovery has only begun." 4) "If you don't continue with follow-up care, you won't hear about relapse prevention."
"Anyone can slip. Relapse commonly occurs during the first few months after a treatment program." The client's statement "I know I'll never drink again" reflects overconfidence, one of the symptoms of relapse. The nurse reminds the client that anyone can slip, that anyone is vulnerable to start drinking again, and that relapse often occurs during the first few months after treatment.
During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? "I trust you not to purge." "I need to know how and when you purge." "Don't worry. I won't allow you to purge today." "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."
"I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat." This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of their diet because they feel they lack control over all other aspects of their lives.
A client, who was hospitalized after a fall sustained while intoxicated, experienced alcohol withdrawal delirium during the hospitalization. A few days after the client's sensorium clears, the client tells the nurse that drinking helps to cope with anxiety related to a recent divorce. Which response by the nurse would help the client view the drinking more objectively? 1) "I'm sure you must realize that sooner or later your drinking will kill you." 2) "I hear defensiveness. You don't really believe what you're saying, do you?" 3) "If the alcohol was helping you cope so well, you wouldn't be here, would you?" 4) "Tell me about the last time you were under a lot of stress and drinking to cope."
"Tell me about the last time you were under a lot of stress and drinking to cope." Helping the client see alcohol as a cause, not a solution, to life problems is an objective and productive response. This response will assist the client to become receptive to the possibility of change.
A nurse is teaching new staff members about groups considered at highest risk for suicide. Which group should the nurse emphasize? Adolescents, those in chronic pain, and persons who are unemployed Women, divorced persons, and substance abusers Alcohol abusers, widows, and young married men Depressed persons, physicians, and persons living in rural areas
Adolescents, those in chronic pain, and persons who are unemployed Studies of those who commit suicide reveal the following high-risk groups: adolescents; those in chronic pain; persons who are unemployed; divorced, widowed, and separated persons; professionals, such as physicians, dentists, and attorneys; students; unemployed persons; persons who are depressed, delusional, or hallucinating; alcohol or substance abusers; and persons who live in urban areas.
A client newly admitted to a psychiatric inpatient setting demands a soda from a staff member who tells him to wait until lunch arrives in 20 minutes. The client becomes angry, pushes over a sofa, throws an end table, and dumps a potted plant. Which goal should a nurse consider to be of primary importance? Talking with the client's family about his angry feelings Performing an assessment for tardive dyskinesia Learning to effectively express needs to staff and others Demonstrating control over aggressive behavior
Demonstrating control over aggressive behavior The client must demonstrate control over his aggressive behavior so that he won't hurt himself or others or destroy property in the hospital setting.
A client is admitted for detoxification following a cocaine overdose. The client reports frequent cocaine use but claims the ability to control use. Which coping mechanism is the client using? withdrawal logical thinking repression denial
Denial is an unconscious defense mechanism in which emotional conflict and anxiety are avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable.
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. Establishing a consistent eating plan and monitoring the client's weight are important for treatment of this disorder. Because control issues play a central part in anorexia nervosa, clients are likely to be more compliant if they take part in developing the eating plan.
The nurse provides care to a client with chemical dependency. What are the primary nursing considerations for this client? Select all that apply. 1) Teach the client to deal with life stressors through coping skills. 2) Support the client's decision to stop substance use. 3) Encourage the client to make restitution for the wrongs committed while using. 4) Promote family interaction and involvement in the rehabilitation process. 5) Encourage the client's family to take responsibility for the client.
Teach the client to deal with life stressors through coping skills. Support the client's decision to stop substance use. Promote family interaction and involvement in the rehabilitation process.
For a client with anorexia nervosa, which goal takes the highest priority? 1) The client will establish adequate daily nutritional intake. 2) The client will make a contract with the nurse that sets a target weight. 3) The client will identify self-perceptions about body size as unrealistic. 4) The client will verbalize the possible physiological consequences of self-starvation.
The client will establish adequate daily nutritional intake. According to Maslow's hierarchy of needs, all humans must first meet basic physiologic needs. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need.
A client experiencing acute alcohol withdrawal is upset about going through detoxification. Which goal should be the priority for the nurse? The client will commit to a drug-free lifestyle. The client will work with the nurse to remain safe. The client will drink adequate fluids daily. The client will make a personal inventory of strengths.
The client will work with the nurse to remain safe. The priority goal in alcohol withdrawal is maintaining the client's safety.
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
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.
A nurse is caring or a client who has experienced frontal lobe damage in a car accident. Which psychosocial behaviors are indications of this damage? Select all that apply. a change in personality overt sexual behavior difficulty controlling temper fewer spontaneous facial expression inability to go out in public settings a disinterest in family relationships
a change in personality overt sexual behavior difficulty controlling temper fewer spontaneous facial expression The frontal lobes are considered our emotional control center and home to our personality. They are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. Also, those with frontal damage display fewer spontaneous facial movements, spoke fewer words or the opposite, spoke excessively
An adolescent client is being admitted with an eating disorder. Which initial assessment finding is of greatest concern for the nurse? a systolic blood pressure of 100 mm Hg a weight loss of 10% over 6 months a potassium level of 2.5 mEq/L (2.5 mmol/L) a heart rate of 57 bpm
a potassium level of 2.5 mEq/L (2.5 mmol/L) Hypokalemia can result from excessive vomiting or laxative use in clients with eating disorders. Potassium levels of 2.5 mEq/L (2.5 mmol/L) or less are considered life-threatening and in need of urgent attention
A nurse is employed at an outpatient rehabilitation facility caring for clients withdrawing from opioids. When assessing clients who present for their counseling session, which findings are anticipated at this time? Select all that apply. abdominal cramps dry, warm skin rhinorrhea dilated pupils hypersomnia feelings of hunger
abdominal cramps rhinorrhea dilated pupils Opioid withdrawal refers to the wide range of symptoms that occur when stopping or dramatically reducing opiate drugs. Opioid withdrawal commonly manifests as abdominal cramps, rhinorrhea, dilated pupils, and anorexiaZ
While teaching a group of parents whose children have Tourette syndrome, a nurse is asked about factors associated with its development. Which factor should the nurse include in the response? infection and maternal alcohol use during pregnancy abnormalities in brain neurotransmitters and the caudate nucleus, and genetics abnormalities in ventricular structure and function environmental factors and birth-related trauma
abnormalities in brain neurotransmitters and the caudate nucleus, and genetics
A nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding suggests that the client has an eating disorder? hyperkalemia increased blood pressure oily skin excessive and ritualized exercise
excessive and ritualized exercise A client with an eating disorder will normally exercise to excess in an effort to burn as many calories as possible.
A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to: avoid shopping for large amounts of food. control eating impulses. identify a connection between anxiety and eating behaviors. restrict eating to three meals per day.
identify a connection between anxiety and eating behaviors. Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety
A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, a nurse asks when the client had the last alcoholic drink. The client says that the last drink was 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to peak: immediately. in 1 to 2 days. within 2 to 7 days. after 7 days.
in 1 to 2 days. Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Alcohol withdrawal delirium may occur 2 to 4 days — even up to 7 days — after the last drink.
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 with anorexia nervosa is at risk for death from self-starvation. Therefore, initiating caloric and nutritional therapy takes highest priority.
A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. At the beginning of the client's hospitalization, the most important nursing action is to: 1) severely restrict the client's physical activities. 2) weigh the client daily, after the evening meal. 3) monitor the client's vital signs, serum electrolyte levels, and acid-base balance. 4) instruct the client to keep an accurate record of food and fluid intake.
monitor the client's vital signs, serum electrolyte levels, and acid-base balance. An anorexic client who requires hospitalization is in poor physical condition as a result of starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid-base balance is crucial.
A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation in the anteroseptal leads and T-wave inversion in leads V3 to V5. Which medication should the nurse prepare to administer? lidocaine procainamide nitroglycerin epinephrine
nitroglycerin The elevated ST segments in this client's ECG indicate myocardial ischemia. To reverse this problem, the physician is most likely to order an infusion of nitroglycerin to dilate the coronary arteries.
A nurse is assigned to care for a client with anorexia nervosa. During the first 48 hours of treatment, which nursing intervention is most appropriate for this client? 1) providing one-on-one supervision during meals and for 1 hour afterward 2) letting the client eat with other clients to create a normal mealtime atmosphere 3)trying to persuade the client to eat and thus restore nutritional balance 4)giving the client as much time to eat as desired
providing one-on-one supervision during meals and for 1 hour afterward Because a client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 to 2 hours afterward.
A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: tension and irritability. slow pulse. hypotension. constipation.
tension and irritability. Amphetamines are a nervous system stimulant that are subject to abuse because of their ability to produce wakefulness and euphoria. An overdose increases tension and irritability.
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 Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake.
A client struggling with a binge eating disorder tells a nurse, "I don't know why I eat the way I do each night." What question would be most helpful for the nurse to ask this client? "What do you do when you feel stressed or upset?" "Do you worry that bad things will happen to you?" "Are there periods of time at night that you can't account for?" "Have you experienced changes in your leisure activities?"
"What do you do when you feel stressed or upset?" Asking what the client does when they feel stressed or upset is appropriate because clients with binge eating disorder commonly use eating as a distraction from unpleasant or negative feelings.
A clinic nurse is assigned to care for a suicidal client. During the preinteraction phase, what should the nurse's priority be? 1) assessing the client's home environment and relationships outside the hospital 2) exploring the nurse's own feelings about suicide 3) discussing the future with the client 4) referring the client to a member of the clergy to discuss the moral implications of suicide
exploring the nurse's own feelings about suicide The nurse's values, beliefs, and attitudes toward self-destructive behavior influence the responses to a suicidal client; such responses set the overall mood for the nurse-client relationship. Therefore, the nurse must initially explore personal feelings about suicide to avoid conveying negative feelings to the client.
A client is voluntarily admitted to a substance use disorder unit. The client admits to drinking at least 1 qt (1 L) of vodka each day and occasionally using cocaine. Several hours after admission, a nurse suspects that the client is likely experiencing early alcohol withdrawal. What assessment findings will the nurse document as evidence of alcohol withdrawal? 1) vomiting, watery frequent diarrhea, and pulse below 80 beats/minute 2) dehydration, temperature above 101°F (38.3°C), and pruritus 3) blood pressure of 90/50 mmHg, decreased appetite, and somnolence 4) pulse of 135 beats/minute, blood pressure of 160/90 mmHg, and nervousness
pulse of 135 beats/minute, blood pressure of 160/90 mmHg, and nervousness Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability.
An adolescent has voluntarily been admitted for treatment of a relapse of anorexia nervosa. The client has a current body mass index (BMI) of 13, down from 16 since discharge 5 months ago. The caregivers are eager to begin a feeding regimen immediately. What teaching should the nurse provide to the caregivers? 1) "We have to be sure the client is agreeable to treatment. Until then, we just have to be patient." 2) "I hear that you are concerned about this weight loss. We will start treatment and keep you updated." 3) "I have to establish the baseline weight and vital signs, and then we can discuss feeding options." 4) "Feeding may not begin until we have determined if there are electrolyte imbalances that need correction."
"Feeding may not begin until we have determined if there are electrolyte imbalances that need correction." The client is at high risk for refeeding syndrome given the degree and length of time of the caloric deficit and having a BMI of less than 15 kg/m2. The nurse should teach the caregivers about the risk for serious complications occurring if electrolyte imbalances are not corrected prior to beginning to supply calories to the client. The client and caregivers can also be reassured that these imbalances can be corrected quickly, usually in less than 24 hours.
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? 1) "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." 2) "It may be appropriate for your parent to be referred to a pain management program." 3) "Unfortunately, it's fairly common for clients with pain to increase their use of pain pills over time." 4) "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." Acknowledging the client's child's feelings is the most therapeutic intervention because the child is not likely to hear the nurse's information until their anger and other feelings are addressed and subside.
Which nursing statement is most effective when the nurse is trying to defuse a client's impending violent behavior? "Let's talk about what happened to make you this angry." "This is a good time for you to play cards with me." "Do you feel you need to be alone in your room?" "The crisis team and I will escort you to the seclusion room."
"Let's talk about what happened to make you this angry." In many instances, the nurse can defuse impending violence by helping the client identify and express feelings of anger and anxiety. This approach may help the client verbalize feelings rather than act on them.
A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells a nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk." What is the most appropriate response? 1) "If you aren't an alcoholic, what leads you to keep drinking and ending up in the hospital?" 2) "It's your decision. If you don't want to go, you don't have to." 3) "The meetings are a part of your treatment. You seem upset about attending them." 4) "You have to go to the meetings even if you don't like attending them."
"The meetings are a part of your treatment. You seem upset about attending them." The substance abuser uses the substance to cope with feelings and may deny the abuse. Presenting information in a mater-of-fact manner conveys the nurse's expectation the client will attend. Asking if the client is upset about attending the meetings encourages the client to identify and deal with the feelings instead of bottling them up.
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? 1) "Your child is ill and can't make decisions about health care and safety right now, but this situation is temporary." 2) "You don't have the right to declare your child incompetent. Your child has rights, too." 3) "I'll help you contact the hospital legal representative for help with the paperwork." 4) "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." The client is temporarily unable to make decisions about health care and safety. After receiving emergency care and treatment, the client will probably be able to safely manage daily affairs.
A client found sitting on the floor of the bathroom in the day treatment clinic has moderate lacerations on both wrists. Surrounded by broken glass, the client sits staring blankly at the lacerations. What is the most important action for the nurse to take toward the client? 1) Enter the room quietly and move next to the client to assess the injuries. 2) Call for staff back-up before entering the room and restraining the client. 3) Sit quietly on the floor next to the client. 4) Approach the client slowly while speaking in a calm voice, calling the client by name, and saying that the nurse is there to help.
Approach the client slowly while speaking in a calm voice, calling the client by name, and saying that the nurse is there to help. Ensuring the safety of the client and the nurse is the priority at this time. Therefore, the nurse should approach the client cautiously while calling the client's name and talking in a calm, confident manner. The nurse should keep in mind that the client shouldn't be startled or overwhelmed. The nurse should state a desire to help and should carefully observe the client's response. If the client shows signs of agitation or confusion or poses a threat, then the nurse should retreat and request assistance.
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 The client is moving toward meeting the goal because recording and discussing feelings is a constructive way to manage stress.
A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. A behavior contract is planned. To promote client compliance the nurse should anticipate that the contract will be written: by the nurse alone. by the client alone. jointly by the client and the nurse. jointly by the physician and the nurse.
jointly by the client and the nurse. A contract written jointly by the client and the nurse most successfully promotes cooperation and consistent behavior. The most effective contract — and the type least likely to allow for manipulation and misinterpretation — describes the behavioral terms as concretely as possible.