Term 5 Unit 3 ex

The nurse is caring for a client and family member who are distressed about not having a concrete medical diagnosis. The client states, "I have been through a lot of tests, and I still know nothing. "When confirming a psychobiologic diagnosis, the nurse is most accurate to state which of the following?

" Confirmation is achieved by ruling out other diseases that manifest similar symptoms." Unfortunately, it takes time to obtain a definitive diagnosis for a psychobiologic disorder. Diagnosis is frequently achieved by ruling out other diseases which manifest similar signs and symptoms. Stating the circumstances in the delay in diagnosis is the best and most accurate explanation. Simply saying that the test will conclude soon and that it takes time to receive reports from specialists in general and does not assist the client in understanding why waiting for the reports are necessary. Psychotherapy provides a component of assessment data but not the best

The nurse is caring for a client who has recently lost a spouse. Which question asked by the nurse is essential in guarding the client's immune system?

"Do you have friends and family to support you?" When a client has very intense stress, such as the loss of a spouse, stress can lower the number of white blood cells impacting the immune system. There is also a connection between poorer immune function and loneliness. Asking the client about friends and family who are available to provide support is most helpful. Friends and family allow the client to share emotions and immune function improves. The other questions provide helpful data but not as pertinent to the immune system.

Which statement by a client indicates teaching about cocaine use has been effective?

"I started using cocaine more and more until I couldn't stop." This statement reflects the trajectory or common pattern of cocaine use and indicates successful teaching. The first statement reflects the client's denial. People gravitate to the drug and continue its use because it gives them a sense of well-being, competency, and power. Cocaine abusers tend to be binge users and can be drug-free for days or weeks between use, but they still have a drug problem. The fourth statement indicates the client is in denial about the drug's potential to become a habit; effective teaching didn't occur.

The nurse is consulting with a client who verbalizes extreme stress. When the nurse asks the client how life is treating him or her, which response represents hardiness in character?

"Life is challenging. I take it as it comes." The nurse would be correct to select the response that represents the effective coping style of hardiness as the client that identifies life as a challenge but coping with life situations as they arise. Clients who respond negatively with a sense of helplessness or indifferent are not representing hardiness.

The nurse has been talking to a client who has had difficulty coping with a new situation. The nurse has met with the client a number of times but each time the client is reluctant to talk about the situation or the feelings associated with it. Which statement by the nurse would be MOST helpful to the client in this situation?

"Many people who have difficulty talking about a situation are able to write about it. I would suggest spending some time each day writing about your feelings." It is the role of the nurse to assist the client in identifying positive strategies to deal with stress. If a client has difficulty verbalizing feelings, it is helpful to suggest that the client write about them in a journal. It is not helpful to the client for the nurse to walk away from the situation. Deep breathing can be an effective coping mechanism but the issue is that the client is unable to talk about the situation. Walking 5-10 minutes each day can be helpful and then working up to more vigorous exercise. Telling a client to run for 30 minutes is too strenuous.

A client who has attempted to quit smoking and failed two times before is reluctant to make another attempt. Which response by the nurse is most appropriate?

"Most people who have tried and failed ultimately do succeed." Attempts to quit are a predictor of eventual success, and many of those who have tried and failed do ultimately succeed. Providing the client with this encouragement supports the desire to quit. Waiting until the time is right may postpone the urge to quit. The nurse does not "know" for certainty that a client is going to achieve a goal but can be a supporter during the process. Although having a plan to follow is important, the support and encouragement to take the first step is the spring board.

A nurse is working in a university health center. A 20-year-old client comes to the center with vague complaints. The client states that she's been cramming for a final examination scheduled for the next day. The nurse suspects that the client is experiencing anxiety. Which of the following statements from the client would most support the nurse's suspicions?

"My stomach feels really upset--sometimes like I'm going to vomit." The client's statement about an upset stomach suggests anxiety. Muscle tension, cold and flu symptoms, headaches, and appetite changes also suggest anxiety.

The nurse is instructing a community education class on stress. The nurse asks the participants, "Is all stress bad for you?" Which answer by the participants is most accurate?

"No, the right amount of stress can be motivating to accomplish goals." The most accurate answer is the participant that states that not all stress is bad because the right amount of stress can be motivating. Just the right amount of stress, called eustress, is what maintains a healthy balance in life.

A client with a history of alcohol abuse refuses to take vitamins. Which statement is most appropriate for explaining why vitamins are important?

"Prolonged use of alcohol can cause vitamin depletion." Chronic alcoholism interferes with the metabolism of many vitamins. Vitamin supplements can prevent deficiencies. Taking vitamins won't stop the craving for alcohol or help a damaged liver heal. A balanced diet is essential in addition to taking multivitamins.

A client has lost her job and is getting divorced. She comes to the clinic with an infection. During discussion, the client asks the nurse if stress might have caused the illness. Which of the following is the best response by the nurse?

"Stress can lower the numbers of white blood cells, which are the immune system's disease fighters." Stress can lower the numbers of white blood cells, the immune system's disease fighters. This statement provides an accurate and direct response to the client's question. The nurse could follow up by asking where the client heard of the connection between body and mind; however, it is not the best initial response. While research does continue in the area of stress and physiologic defense mechanisms, this response does not provide the client with a useful answer. Several responses may be related to stress, and it is not more likely that the client would have manifested with an allergy over an infection.

A client tells the nurse that drinking helps him cope with anxiety. Which response by the nurse would help the client view drinking more objectively?

"Tell me what happened the last time you felt 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. The other responses directly confront and attack defenses against anxiety that the client still needs and may reflect the nurse's frustration with the client.

A nurse is working with a client to integrate effective coping skills into the client's life. What activities will the nurse suggest to the client? Select all that apply.

*Explore coping strategies the client has found helpful in the past and encourage their continued use. *Re-establish priorities to strike a healthy balance between work and play. *Cultivate relationships with family and friends who are supportive. Activities to enhance coping include exploring the coping strategies the client has found helpful in the past and encouraging their continued use, encouraging clients to reestablish priorities and to strike a healthy balance between work and play, and suggesting cultivating relationships with family and friends who are supportive. The client needs to develop both long- and short-term goals. The client should not focus on anger management, but needs to have anger management outlets.

Which of the following responses is most helpful to the client when in an emergency situation?

A response by the sympathetic nervous system The most common pathway for the stress response is through the sympathetic nervous system, which uses norepinephrine to stimulate body systems, arousal, and anxiety in response to stress. This response overrides the control of the parasympathetic nervous system, which slows metabolic processes. The cardiovascular system and musculoskeletal system respond because of sympathetic stimulation.

The nurse is planning a community health promotion program on stress and stress reduction. The nurse describes which action as the physiologic response to exposure to long-term, persistent stress?

Activation of the hypothalamic-pituitary system The initial response to stress is sympathetic nervous system discharge, followed by sympathetic-adrenal-medullary discharge. If the stress persists, the hypothalamic-pituitary system is activated.

A client is being treated for alcoholism. Which organization can be recommended to assist the family in coping with this disease?

Al-Anon Al-Anon is a support group for family of alcoholics. Alcoholics Anonymous and Rational Recovery are types of alcoholism recovery programs.

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. The nurse recognizes these symptoms as typical of which of the following?

Alcohol withdrawal syndrome Withdrawal from alcohol produces shakiness, weakness, diaphoresis, and GI symptoms. These are not symptoms of continuing intoxication. Delirium tremens produce hypertension, delusions, hallucinations, and agitated behavior. Wernicke-Korsakoff's syndrome is a type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or Vitamin B6 deficiency.

The nurse is developing a plan of care to assist a patient in coping with a below-the-knee amputation (BKA) on the right leg. Which intervention should the nurse include?

Allow client to verbalize feelings of loss Nursing interventions to enhance client's ability to cope with stressful events include allowing the client to verbalize feelings of loss, such as those associated with the loss of a lower extremity. The nurse should also encourage objective, not subjective, appraisal of the event by the client, and assist the client in establishing mutual client nursing goals, not nurse-determined goals. If the client desires, the nurse should assist the client to use other forms of alternative therapy such as meditation, music therapy, etc.

Which instructions should a nurse provide to a client with alcohol dependence before administering the prescribed thiamine?

Avoid glucose solutions. Because thiamine is essential for the metabolism of glucose, glucose solutions must be avoided until thiamine is administered.

Which of the following instructions should a nurse provide a client with alcohol dependence who is prescribed disulfiram?

Avoid mixing disulfiram and alcohol. The nurse should advise the client to avoid mixing disulfiram and alcohol because life-threatening cardiopulmonary complications and even death can occur.

A nurse is developing strategies to prevent relapse with a client who abuses alcohol. Which client intervention is important?

Avoiding people, places, and activities from the former lifestyle Changing the client's old habits is essential for sustaining a sober lifestyle. Certain OTC medications that don't contain alcohol will probably need to be used by the client at certain times. It's unrealistic to have the client abstain from all such medications. Contact with the client's family may not be a trigger to relapse, so limiting contact wouldn't be useful. Refraining from group activities isn't a good strategy to prevent relapse. Going to Alcoholics Anonymous and other support groups will help prevent relapse.

The nurse is caring for a client with an anxiety disorder. The client reports feelings of anxiousness when in social situations. Which classification of medications does the nurse anticipate?

Benzodiazepines The nurse is correct to anticipate that client with an anxiety disorder would be prescribed a medication from the benzodiazepine classification. Adrenergic blockers and corticosteroids offer antianxiety properties. Antipsychotic medications offer a wide range of changes in brain chemistry in addition to antianxiety effects, which may occur in some medication types.

The nurse walks into a client's room and find the client sobbing uncontrollably. The client states, "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On the client's care plan, the nurse reads that there is a pre-existing nursing diagnosis of Ineffective Coping related to stress. What outcome is most appropriate to this client's care?

Client will adopt coping mechanisms to reduce stress. Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the client needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a client to be stress free; avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping.

A nursing student has presented a concept map of a medical client's health that demonstrates the maintenance of a steady state. The student has elaborated on the relationship of individual cells to compensatory mechanisms. When do compensatory mechanisms occur in the human body?

Continuously The concept of the cell as existing on a continuum of function and structure includes the relationship of the cell to compensatory mechanisms, which occur continuously in the body to maintain the steady state

The nurse is caring for an adult client who has just received a diagnosis of prostate cancer. The client states that he will "never be able to cope with this situation." How should the nurse best understand the concept of coping when attempting to meet this client's needs?

Coping is composed of the physiologic and psychological processes that people use to adapt to change. Indicators of stress and the stress response include both subjective and objective measures. They are psychological, physiologic, or behavioral and reflect social behaviors and thought processes. The physiologic and psychological processes that people use to adapt to stress are the essence of the coping process. Coping is both a physiologic and psychological process used to adapt to change. Coping is a personal process used to adapt to change.

A nurse is assisting a client to foster better coping skills. Which of the following strategies would the nurse suggest to the client? Select all that apply.

Cultivate relationships with family and friends who are supportive. Write about angry feelings in a diary. The nurse would suggest that the client cultivate relationships with family and friends who are supportive and write about feelings in a diary if verbalizing traumatic or angry thoughts is difficult. The nurse would explore coping strategies helpful in the past and encourage their continued use, not just tell the client to start with all brand-new strategies. He or she would also advise the client to say ''no'' to unreasonable requests and implement time-management techniques like getting up earlier and performing stressful tasks when the client has maximum energy. The client is unlikely to have maximum energy at the end of the day.

Which of the following interventions should a nurse recommend for fostering effective coping skills and a sense of hardiness?

Daily exercise A nurse should recommend a daily exercise program to reduce stimulating neurotransmitters and release endorphins and enkephalins. Diet and periodic checkups are not essential to foster effective coping skills and a sense of hardiness. It is essential for the client to avoid a nonprescribed sedative drug for self-treatment because it does not foster effective coping skills and a sense of hardiness.

The nurse is assessing a client with a history of alcohol abuse. Which of the following is the most common defense mechanism used by a client diagnosed with a substance use problem?

Denial Substance use typically includes the use of defense mechanisms, especially denial. Clients may deny directly having any problems or may minimize the extent of problems or actual substance use.

A patient has been using cocaine on a regular basis. She has run out of the drug and is unable to obtain more. Within hours of stopping the medication she begins to show symptoms of cocaine withdrawal. What symptoms will the patient exhibit?

Depression, drowsiness, and fatigue Cocaine withdrawal begins within hours of stopping drug use and last up to several days. Symptoms include depression (which may be profound), drowsiness, fatigue, and sleep disturbance. Euphoria, hyperactivity, hyperalertness, diaphoresis, clammy palms, diarrhea, chest pain, palpitations, and diaphoresis are not symptoms of withdrawal from cocaine abuse.

A client recovering from alcohol abuse needs to develop effective coping skills to handle daily stressors. Which intervention is most useful to the client?

Discussing examples of successful coping behavior The client needs help identifying a successful coping behavior and developing ways to incorporate that behavior into daily functioning. There are many skills for coping with stress, and determining the client's level of verbal skills may not be important. Encouraging the client to avoid conflict or to accept uncomfortable situations prevents him from learning skills to handle daily stressors.

Which of the following conditions triggers the general adaptation syndrome?

Distress Excessive, ill-timed, or unrelieved stress is called distress. It triggers the general adaptation syndrome, a nonspecific physiologic response. Eustress means the right amount of stress and maintains a healthy balance in life. It cannot trigger a general adaptation syndrome. The placebo effect refers to healing or improvement that takes place because the person believes a treatment method will be more effective. Helplessness is a psychological factor that makes a client with stress disease prone. It is not a condition that triggers the general adaptation syndrome.

Which neurotransmitter influences movement and memory?

Dopamine Dopamine influences movement, memory, thoughts, and judgment. Acetylcholine assists with memory storage. Norepinephrine affects attention and concentration. Serotonin stabilizes the mood.

Which treatment modality is particularly useful in mood disorders?

Drug therapy Drug therapy aims at correcting the underlying biochemical abnormality and is particularly useful with mood disorders.

A client is not dealing well with the diagnosis of cancer. She feels she is "so alone." Which intervention would be most appropriate for this client?

Educate the client on the availability of support groups for clients with cancer. Support groups exist for people in similar stressful situations. They allow a person freedom of expression and exchange of ideas.

The nurse is caring for an older female client who is being treated for acute anxiety. She has a nursing diagnosis of Ineffective Coping related to a feeling of helplessness. What would be the most appropriate nursing intervention?

Encourage an attitude of realistic hope to help her deal with helpless feelings. By encouraging an attitude of realistic hope, the client will be empowered. This allows the client to explore her feelings and bring about more effective coping patterns. The onus for care planning should not lie with the client. The nursing diagnosis is related to feeling of helplessness, not anger and hostility. Social support is necessary, but does not directly address the feeling of helplessness.

The psychiatric community nurse is working with a highly culturally diverse group of mostly young adult clients who have substance abuse issues. Many clients have had difficult social circumstances and experience relapses. What would be the most appropriate nursing intervention in dealing with these clients?

Encourage motivation and confidence so that the clients can better deal with the triggers that cause them to repeat their behaviors Clients with multiple episodic occurrences of release are unable to adapt to the stressors but need support. Zero tolerance to relapse demonstrates an authoritarian attitude that the clients have a weakness in character. Providing reassurance that the problem will resolve itself in time does not motivate change. Providing coping strategies for the clients does not instill personal commitment to change.

Which condition is most commonly found in a client who chronically abuses alcohol?

Enlarged liver A major effect of alcohol on the body is liver impairment, and an enlarged liver is a common physical finding. Nasal irritation is commonly seen in clients who snort cocaine. Muscle wasting and limb paresthesia don't tend to occur in clients who abuse alcohol.

A nurse is helping a client with a stress-related disorder to foster improved coping skills. Which of the following measures would the nurse be most likely to suggest?

Explore the coping strategies the client has found helpful in the past and encourage their continued use. The nurse would explore the coping strategies the client has found helpful in the past and encourage their continued use. The nurse would also correctly encourage the client to strike a healthy balance between work and play (not focus more heavily on one than the other), engage in a daily exercise program (not one that is three times a week only), and avoid using alcohol or other nonprescribed sedative drugs as forms of self-treatment.

A client consumed alcohol almost daily while she was pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol?

Fetal Alcohol Syndrome Alcohol is a teratogen, meaning that it crosses the placenta when women drink during pregnancy and can cause adverse fetal effects. The most clearly alcohol-related birth defect is a specific pattern called fetal alcohol syndrome (FAS), the leading known preventable cause of intellectual disability. Manifestations of FAS include prenatal and postnatal growth deficiency; facial malformations, including a small head circumference, flattened midface, sunken nasal bridge, and flattened and elongated groove between nose and upper lip; CNS dysfunction; varying degrees of major organ system malfunction.

A student is feeling stressed regarding upcoming exams, family situation, and other life events. What conditions might be exacerbated as a result of this stress? Select all that apply.

GI tract disorders diabetes mellitus Stress has been implicated in the development or exacerbation of autoimmune diseases, anorexia nervosa, obsessive compulsive disorder, panic attacks, thyroid conditions, heart disease, chronic pain conditions, and diabetes.

A client who has had a traumatic experience states that he has no lasting effects from this experience. His wife disagrees. Which of the following will the nurse assess if the wife is correct about the lasting stress?

High blood pressure, palpitations Stressors exist in many forms and categories. Stressors are classified as (1 day-to-day frustrations, (2) major complex occurrences involving large groups, and (3) less frequent stressors involving fewer people. The second group influences larger groups, even nations. These include events of history such as terrorism. High blood pressure and palpitations are physiologic responses of stress.

A teenage boy who was the victim of a near-drowning has been admitted to the emergency department. The client was submerged for several minutes and remains unconscious. What pathophysiologic process has occurred as a result of the submersion?

Hypoxia to the brain The length of time different tissues can survive without oxygen varies. The brain will become hypoxic in 3 to 6 minutes. The other options are incorrect because submersion injuries do not cause atrophy to brain cells right away; submersion injuries also do not cause cellular lysis or necrosis to the brain.

The nurse is obtaining a health history from a client with stress-related illnesses. When the nurse asks the client how the client copes with stress, which coping mechanism causes the nurse the most concern?

I run eight hours per day The nurse is most concerned about the maladaptive coping mechanism of running eight hours per day. Playing video games, exercising or lifting weight, and going out with friends are more positive, beneficial coping mechanisms which, if done appropriately, can reduce stress.

A 47-year-old male has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, he admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?

Imbalanced nutrition: less than body requirements related to chronic alcohol intake High alcohol intake is associated with malnutrition, which can result in low electrolyte levels, low BMI, and impaired skin integrity. This diagnosis is of more immediate concern than the client's coping, knowledge, or future risk for injury.

The nurse is assessing a client and palpates two enlarged supraclavicular lymph nodes. The nurse asks the client how long these nodes have noticeably enlarged. The client states, "I can't remember. A long time I think. Do I have cancer?" Which of the following is an immediate physiologic response to stress the nurse would expect this client to experience?

Increased blood pressure An initial response to stress, as seen by the fight-or-flight response, is an increase in the client's heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.

Which condition is a sympathetic-adrenal medullary response to stress?

Increased heart rate

A client has presented to the local health center with a large mass in her right breast. She has felt the lump for about a year, but was afraid to come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this client?

Ineffective individual coping related to reluctance to seek care Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case, the client was unable to access health care even when she was aware the disorder could be life-threatening. Self-esteem Disturbance, Altered Family Process, and Ineffective Denial are all nursing diagnoses that are often associated with breast cancer, but the client's ineffective individual coping has created a significant safety risk and is, therefore, the most appropriate nursing diagnosis. She did not deny the severity of the finding, but rather feared it and was unable to cope.

When discussing methadone treatment with a client, the nurse teaches what?

It decreases the severity of heroin withdrawal symptoms. Methadone is a substitute for heroin, reducing the severity of heroin withdrawal symptoms. It does not cure heroin addiction, and it is an addictive drug.

A client experiences a stressor and states "my heart is beating so fast and my breathing is fast, too." What is the purpose for the client's increased heart rate and respiratory rate as related to stress?

It provides oxygen for energy and improves perfusion to vital organs. The sympathetic-adrenal-medullary response to stress increases the heart rate to allow for better perfusion of vital organs. Rapid, shallow respirations provide oxygen for energy and dilating the bronchi.

Which of the following suggestions made by the nurse is most helpful in developing effective coping through the aging process?

Make life decisions. The nurse is correct to encourage the aging client to maintain a sense of control by making his or her life decisions. Limiting medication use depends on the client's health. Avoiding friends can cause alienation. Managing personal care is helpful, if able, but not as important as making life decisions.

The nurse is assessing a client and learns that the client and his wife were married just 3 weeks earlier. What principle should underlie the nurse's care planning for this client?

Marriage causes transition, which has the potential to cause stress. Transition can contribute to stress, even if the transition is a positive change. The third group of stressors has been studied most extensively and concerns relatively infrequent situations that directly affect people. This category includes the influence of life events such as death, birth, marriage, divorce, and retirement. Counseling is not necessarily indicated.

After a long history of intravenous heroin use, a client has expressed willingness to stop using heroin. The nurse would expect the client to receive which medication to decrease the severity of withdrawal?

Methadone Methadone is given to clients who abuse opioids and synthetic substances to replace their usual substance of abuse because it decreases the severity of withdrawal.

A client has come to the clinic with a fever and sore throat. This is his first visit in 18 months. The nurse notices that the client has acne, lesions, and scratch marks. Additionally, the client's teeth are broken, rotting, and discolored; the client's chart shows no indication of any previous tooth problems. He also weighs 20 lbs less than at his last appointment. What type of addiction would the nurse suspect may be apparent in this client?

Methamphetamine Methamphetamine users may develop acne and be covered with multiple scratched lesions. Some users have tactile hallucinations and believe that insects are crawling under their skin, which causes them to scratch their face, hands, and arms. The constriction of blood vessels makes the resulting lesions slow to heal. Methamphetamine use also causes the salivary glands to dry out, leading to a wearing away of the tooth enamel from acids in the mouth. Oral tissues decay from impaired blood supply. This condition is sometimes referred to as ''meth mouth'' because of the characteristic appearance of broken, discolored, and rotting teeth. Extreme weight loss is also common.

The nurse is presenting a poster at a workshop and includes information from a new emerging area of medicine called psychobiologic disorders. The nurse is most correct to state that this area links which of the following?

Mind and body Psychobiologic disorders are an area which links the mind and the body. Psychobiologic disorders present conditions in which evidence confirms a connection between abnormalities in the brain and altered cognition, perception, emotion, behavior, and socialization.

Which test does a nurse administer regularly on a client with stress?

Mini-Mental State Examination (MMSE) A nurse regularly conducts MMSE.

A client has overdosed on opiates. Which drug would the nurse anticipate being ordered for this client?

Naloxone Opiate overdose leads to respiratory depression, unconsciousness, and death. Naloxone is administered to reverse the effects of opiates and assists in restoring respiration. Naltrexone is an opiate antagonist that is used for rapid opiate detoxification while the client is under anesthesia. Dolophine and hydromorphone are opiate drugs and would increase the effects of respiratory depression.

A client is receiving treatment for opioid toxicity. Which drug reverses opioid toxicity?

Naloxone (Narcan) Narcan reverses opioid toxicity.

A client tells a nurse, "I've been feeling so stressed lately. I almost feel paralyzed all the time. I never know how to even get started." What would the nurse consider as the physiologic basis for this response from the client?

Parasympathetic nervous system The client's report is consistent with responding to stressors through the parasympathetic nervous system. Instead of being stimulated to fight or flee (as with the sympathetic nervous system), parasympathetic responders become frozen by fear.

Which of the following assessment findings is most important in determining the presence of alcohol dependency in a client? Select all that apply.

Patterns of use Absenteeism from work Blackouts People who are dependent on alcohol are driven by the pattern of use and how or when to obtain alcohol. They begin drinking earlier in the day and create opportunities to drink. Loss of work hours, especially on Mondays, becomes a pattern. Blackouts or loss of episodes of time can occur in the early and later stages of the abuse. Weight loss and fluctuation in appetite may be associated with alcohol abuse but not a determining factor. Blurred vision is not significant in the assessment of the disorder.

A nurse is collecting data from a client with a history of cocaine abuse. Which condition might typically be found with this client?

Perforated nasal septum The client who snorts cocaine frequently commonly develops a perforated nasal septum. Glossitis, bilateral ear infections, and pharyngitis aren't common physical findings for a client with a history of cocaine abuse.

Which of the following assessment findings is observed in a client with opiate use?

Pinpoint-sized pupils The assessment findings in a client with opiate use are pinpoint-sized pupils, constipation, weight loss, and anorexia. Diarrhea, weight gain, and bulimia are not the assessment findings observed in a client with opiate dependency.

Which of the following is the result of the appropriate use of coping mechanisms?

Psychological growth When used appropriately and in moderation, coping mechanisms allow maintenance of psychological equilibrium and lead to psychological growth. Appropriate use of coping mechanisms does not alter body functions or symptoms or restore biologic functions.

The nurse is caring for a client whose wife died 4 months ago. He states that he is "not doing well" and that his friends and family seem hesitant to talk with him about his wife. What could the nurse do to help the client?

Refer him to a support group. Being a member of a group with similar problems or goals has a releasing effect on a person that promotes freedom of expression and exchange of ideas. Psychiatry may or may not be necessary. Spiritual assessment would necessarily precede any referral to a specific religious setting. Consciousness-raising groups are not known to be a common source of social support.

A client is experiencing intense stress during his current hospital admission for the exacerbation of chronic obstructive pulmonary disease (COPD). Which of the client's actions best demonstrates adaptive coping?

Reprioritizing needs and roles Adaptive ways of coping included seeking information, reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself to others, planning activities to conserve energy, taking things one step at a time, listening to one's body, and using self-talk for encouragement. Becoming controlling or withdrawing are not ways to cope adaptively. Benzodiazepines are sometimes indicated, but these are not considered to be an adaptive coping behavior.

Following the administration of naloxone to a client who overdosed on opiates, the nurse knows to monitor the client closely for which effect?

Respiratory depression Naloxone is used for partial or complete reversal of opiate induced respiratory depression, but because it is a short-acting drug, respiratory depression may reoccur after its effects wear off. Cerebral edema, liver failure, and seizure activity are not directly associated with opioid overdose.

A nurse is preparing a presentation for a local community group about mental health. When describing a mentally healthy person, which of the following characteristics would the nurse include? Select all that apply.

Satisfaction with life situations Acceptance of reality Positive self image A mentally healthy person is satisfied with self and his or her life situations, focuses on activities to meet needs, accepts reality, has a positive image of himself or herself, and maintains a realistic sense of hope.

The nurse is assessing an older adult client post-myocardial infarction. The nurse attempts to identify the client's health patterns and to assess if these health patterns are achieving the client's goals. How should the nurse best respond if it is found that the client's health patterns are not achieving their goals?

Seek ways to promote balance in the client The nurse has a significant role and responsibility in identifying the health patterns of the client receiving care. If those patterns are not achieving physiologic, psychological, and social balance, the nurse is obligated, with the assistance and agreement of the client, to seek ways to promote balance. The nurse is not obligated to refer to social work, identify alternative forms of care, or provide insight into the physiologic failings of the system if the client's health patterns are not achieving their goals.

A client is admitted to the emergency room suffering from symptoms of alcohol withdrawal. What symptom of withdrawal is the priority to prevent?

Seizures In acute alcohol withdrawal a goal of treatment is to prevent seizures. Bradycardia, hypotension, and gastrointestinal bleeding are not the primary symptoms of acute alcohol withdrawal.

A client with alcoholism has just completed a residential treatment program. What can this client reasonably expect?

She'll need ongoing support to remain abstinent. Addiction is a relapsing illness. Support is helpful to most people in maintaining an abstinent lifestyle. The family dynamics probably will change as a result of the client's abstinence; however, there's no way to predict whether these changes will be healthy. An alcoholic client always remains at risk for abusing alcohol. Addicted people can't consume alcohol in moderation.

A patient with a strong history of breast malignancy in her family is scheduled for a breast biopsy in the morning. What would be the most appropriate nursing action when caring for this patient the evening before surgery?

Sit with her and provide an opportunity for her to talk about her concerns. Emotional support from family and significant others provides love and a sense of sharing the burden. The emotions that accompany stress are unpleasant and often increase in a spiraling fashion if relief is not provided. Being able to talk with someone and express feelings openly may help a person gain mastery of the situation. Nurses can provide this support, but it is important to identify the person's social support system and encourage its use. People who are "loners," who are isolated, or who withdraw in times of stress have a high risk of coping failure.

Which statement most accurately describes the etiology of substance-related disorders?

Substance-related disorders result from the interplay of biologic, genetic, and psychosocial Substance-related disorders have a complex etiology, and contributions have been noted from a combination of neurological, genetic, behavioral, and sociocultural sources.

The nurse is instructing a client in a physician's office. Which instruction is most accurate when advising the client on the feelings of anger?

Suppressing anger and excessively expressing anger can negatively affect the body. It is most accurate to understand that suppressing anger and excessively expressing anger can both lead to physical symptoms including death. The nurse must continue to follow the client's actions and emotions. Expressing anger in an appropriate manner helps to prevent neurochemical changes in the brain. Using exercise is an appropriate manner to relieve stress. Eliminating sources of stress is not appropriate.

A client tells the nurse that she went to a party and had several drinks. When she woke up the next morning, she could not remember driving home. What does the nurse suspect?

The client had a blackout. During a blackout, the person appears to function normally while drinking but later is unable to remember what occurred. The blackout may last a few hours or several days. The person may come out of the blackout period and wonder, "Where did I leave my car last night?" He or she may wake up in a strange city unable to remember leaving home and wonder, "How did I get here?" or "Was I with someone?"

A client was admitted to the hospital last night with a compound fracture of the femur, sustained in a fall while intoxicated. Her condition remains relatively stable; however, she is shaky, irritable, and anxious. She tells about having vivid nightmares for two nights. The next day when the nurse returns from lunch, she finds the client restless and perspiring. Her pulse is 130. She cries, "Bugs are crawling on my bed. I've got to get out of here," and begins to thrash about. What would be the most accurate assessment of the client's situation?

The client is experiencing symptoms consistent with withdrawal delirium The client's symptoms of agitation, elevated pulse, and perceptual distortions relate to the medical emergency of alcohol withdrawal delirium. Her behaviors and physical symptoms are inconsistent with manipulation, head injury, and psychosis (there was also no mention of a previous psychosis in this case).

A nurse accompanies a physician who will be telling a client about positive biopsy results. The family gets up to leave the room. The nurse immediately encourages the family to stay in the room. Which of the following is the nurse's reasoning for having the family stay?

The family will provide emotional support. Social support has been demonstrated to be an effective moderator of life stress. Social support facilitates a client's coping behavior. Emotional support from family provides love and a sense of sharing the burden. While nurses can provide support, family members help a client gain mastery of the situation.

A client is now experiencing acute alcohol withdrawal. What complication should the nurse anticipate based on the present condition?

The increased potential for seizures and hallucinations. The seizure threshold is lowered in the brain with acute alcohol withdrawal. Associated electrolyte imbalances exist. Other answers are incorrect as the client would more likely be hypertensive and tachycardic. Other symptoms are reflective of stroke.

The nurse at the student health center is seeing a group of students who are interested in reducing their stress levels. The nurse identifies guided imagery as an appropriate intervention. What should the nurse include in this intervention?

The mindful use of a word, phrase, or visual, which allows oneself to be distracted and temporarily escape from stressful situations Guided imagery is the mindful use of a word, phrase, or visual image to distract oneself from distressing situations or consciously taking time to relax or reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or humor.

What happens when clients return to opiate abuse while taking naltrexone?

They do not experience the previous level of opiate effects. Naltrexone is used for opiate addiction. When clients return to opiate abuse while taking naltrexone, they do not experience the previous level of opiate effects. They do not have increased potential for overdose and death. In addition, they do not experience any physiologic consequences of withdrawal and are not depressed and prone to commit suicide.

A client with alcoholism is showing cognitive changes consistent with dementia. The nurse is aware that what nutritional deficiency may be contributing to the client's problems?

Thiamine Alcoholism may result in thiamine deficiency, which can lead to dementia.

A client has a blood alcohol level that is double the legal limit for driving yet does not exhibit behaviors of intoxication. The nurse knows that this is due to which effect?

Tolerance Tolerance occurs when the body develops mechanisms to reduce the effects of a drug through persistent use. This results in the need to increase the amount of a substance to obtain the desired effect. Addiction is a term that refers to drug-seeking behavior that interferes with work, relationships, and normal activities. Alcoholism is a chronic, progressive disease characterized by an inability to control the consumption of alcohol in which tolerance develops. Relapse is a term referring to the return to drug or alcohol use after a period of abstinence.

A 51-year-old male has been admitted to the detoxification unit with acute symptoms of alcohol withdrawal. Nursing assessment is likely to reveal what?

Tremors, headache, flushed face, and hallucinations Symptoms of alcohol withdrawal include tremors, headache, flushed face, and hallucinations. The client will experience hypertension (not hypotension), tachycardia (not bradycardia), and diaphoresis (not anhidrosis).

The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:

Underestimate the amount consumed When clients are asked about their substance abuse, they often underestimate the amount consumed. The client does not deny ingestion of alcohol, overestimate the amount consumed, or accurately describe the amount consumed.

Which is the best nursing intervention to prevent a potential depressant action of methadone caused by mixing with another drug?

Urine testing The practice of testing the urine before providing methadone is one way of screening and eliminating those who are abusing the system and trying to potentiate the effects of the methadone by combining with another depressant. The methadone should be administered by a professional and supplied in a liquid form to avoid cheeking of the drug. Addictive clients are drug seeking in nature and cannot be trusted to always be honest with drug use questions and answers. Vital sign monitoring is not significant in the detection of alternate drug use.

A client is taking disulfiram and begins drinking a beer. What effect will be produced from the combination of alcohol and disulfiram?

Vomiting Disulfiram interferes with hepatic metabolism of alcohol and allows the accumulation of acetaldehyde. If alcohol is ingested during disulfiram therapy, acetaldehyde causes nausea, vomiting, dyspnea, hypotension, tachycardia, syncope, blurred vision, headache, and confusion. Disulfiram will not cause hypertension, alertness, or bleeding.

A client comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The client agrees to take disulfiram. The nurse will teach the patient that the combination of alcohol and disulfiram will cause which of the following?

Vomiting The effectiveness of disulfiram relies on a drug interaction between ethanol and disulfiram to produce unpleasant and undesirable symptoms as a deterrent to alcohol ingestion. Symptoms include facial flushing, throbbing headache, hyperventilation, tachycardia, palpitations, nausea and copious vomiting, hypotension, shortness of breath, vertigo, syncope, confusion, and profuse diaphoresis.

Which of the following data is most important for a nurse to obtain when a client with alcohol dependence admits consuming alcohol during the assessment?

When the last drink was consumed When a client with alcohol dependence admits to consuming alcohol, the nurse should determine the type, how much, and when the last drink was consumed. The latter information is most important because withdrawal symptoms occur within 6 to 72 hours after a client's last drink. The client may not be aware of any withdrawal symptoms.

The client, who has recently stopped smoking, is agitated and complaining of a headache. The nurse would interpret this as which of the following?

Withdrawal Agitation and headache are physical symptoms that occur when a person abruptly stops using an abused substance, such as caffeine. Addiction and dependency are terms that refer to drug-seeking behaviors that interfere with work, relationships, and normal activities. Tolerance refers to the reduction in a drug's effect that follows persistent use.

The nurse in the emergency department is caring for a client who has an elevated blood pressure and elevated respirations. The nurse is aware that the client may be experiencing withdrawal from heroin if the client displays which other signs and symptoms? Select all that apply.

Yawning Goosebumps Diarrhea The signs of heroin withdrawal include yawning, running nose, perspiration, goosebumps anorexia, vomiting, diarrhea, dilated pupils, insomnia, elevated vital signs, and drug craving. Pinpoint pupils, respiratory depression, and hypothermia are signs of toxicity.

A nurse teaching family members about the brain's connection to behaviors commonly seen in mental illnesses is using the term "neurotransmitter." The nurse should explain that a neurotransmitter is:

a chemical that is released in the brain. Neurotransmitters are chemicals stored in the neuron and released as neural messengers when stimulated by an electrical impulse. Neurotransmitters are involved with functions that affect human emotions and behavior. They are the targets for drugs used to treat mental illnesses. Neurotransmitters are stored in the axon terminal of the presynaptic neuron. They are not a hormone, nerve, or brain location, nor are they stored in a gland. Rather, they are chemicals that carry messages found within the brain and peripheral nervous system.

A client who has bilateral fractures of the femurs from a fall undergoes a bilateral open reduction and internal fixation, and is admitted after recovering in the PACU. Twenty-four hours after admission to the unit, the client begins to experience hallucinations, agitation, hypertension, and profuse sweating. What might be causing these signs and symptoms?

alcohol withdrawal Withdrawal from alcohol results in nervous system stimulation manifested by tremors, sweating, hypertension, tachycardia, heart palpitations, craving for alcohol, seizures, and hallucinations.

Which newest diagnostic tool might be efficient in diagnosing psychobiologic disorders in the future?

brain mapping Brain mapping is a technique that compares a client's brain activity patterns (from an EEG or other electronic image) with a computerized database of electrophysiologic abnormalities. A growing database of distinctive patterns for seizure disorders, schizophrenia, depression, dementia, anxiety disorders, attention deficit/hyperactivity disorder, and others now exists for comparison

A client is being seen in clinic for a drug abuse problem. Signs and symptoms include burns on the face and fingertips, a chronic cough, and pulmonary congestion. The physician suspects the client is addicted to:

cocaine Burns on the face and fingertips, chronic cough, and pulmonary congestion are seen with smoking cocaine.

A client reports an inability to stop drinking alcohol and is desperate to discontinue the practice. What is the likely reason why this client started drinking?

desire to experiment Substance abuse often begins with curious experimentation.

A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies:

drug tolerance. With drug use over time, tolerance develops. Tolerance occurs when the body develops a natural resistance to the drug's physical or euphoric effects, making it necessary to take increasing doses more frequently to achieve the desired effect.

What is the definition of addiction?

drug-seeking behaviors that interfere with normal life Addiction sometimes is used interchangeably with dependence, but addiction more accurately refers to the drug-seeking behaviors that interfere with work, relationships, and normal activities.

Which neurotransmitter is correlated with schizophrenia?

excess dopamine The disorganized thought patterns and bizarre behavior of schizophrenia have been correlated with excess levels of dopamine.

Which condition is not a consequence of smoking?

gynecologic cancer Gynecologic cancer is not a consequence of smoking. Chronic obstructive lung disease, esophageal cancer, and peripheral vascular disease are consequences of smoking.

The origin of hypochondriasis, an abnormal fixation about one's health, is believed to be:

having received excessive attention and concern from others during childhood illnesses, which were unconsciously perceived as rewarding. It is believed to be caused receiving excessive attention and concern from others during childhood illnesses, which were unconsciously perceived as rewarding.

A client who has a 50-year history of smoking, along with being a recovering alcoholic who drank for 15 years, has developed significant dementia symptoms in the past 6 months. Which historical data could be significant?

heavy alcohol ingestion >10 years Dementia may be associated with heavy ingestion of alcohol for 10 or more years, or with ingestion of other toxic substances, including heavy metals.

What is the definition of dependence?

need for a substance to avoid withdrawal symptoms Chemical dependence means that a person must take a drug to avoid withdrawal symptoms.

The general adaptation syndrome (GAS) is a nonspecific physiologic response to a stressor. Which stage is not a part of the process?

stress awareness stage The general adaptation syndrome can cycle many times through the alarm and resistance stages before reaching the exhaustion stage. The process occurs through the neuroendocrine and autonomic nervous systems.