Silvestri Chapter 64 Ed#57c

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 064 (edited file)—"Addictions" 10/14/08, Page 1 of 9, 0 Figure(s), 0 Table(s), 11 Box(es)

64: Addictions PRACTICE QUESTIONS 1. A nurse is caring for a female client who was recently admitted to the hospital for anorexia nervosa. The nurse enters the client’s room and notes that the client is doing rigorous push-ups. Which nursing action is appropriate? 1. Allow the client to complete her exercise program. 2. Tell the client that she is not allowed to exercise rigorously. 3. Interrupt the client and offer to take her for a walk. 4. Interrupt the client and weigh her immediately. Answer: 3 Rationale: Clients with anorexia nervosa are frequently preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise as well as place limits on rigorous activities. Options 1, 2, and 4 are inappropriate nursing actions. Test-Taking Strategy: Use the process of elimination. Recalling that the nurse needs to set firm limits with clients who have this disorder will direct you to option 3. If you had difficulty with this question, review interventions for the client with anorexia nervosa. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 240-241. 2. A nurse is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that the client with anorexia nervosa manages anxiety by: 1. Always reinforcing self-approval 2. Having the need to always make the right decision 3. Engaging in immoral acts 4. Observing rigid rules and regulations Answer: 4 Rationale: Clients with anorexia nervosa have the desire to please others. Their need to be correct or perfect interferes with rational decision-making processes. These clients are moralistic. Rules and rituals help the clients manage their anxiety. Options 1, 2, and 3 are incorrect. Test-Taking Strategy: Use the process of elimination and focus on the issue, managing anxiety. Eliminate options 1 and 2 because of the absolute word “always.” Eliminate option 3 because it is not characteristic of the client with anorexia. Review the characteristics associated with this disorder if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection

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Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 235. 3. A nursing student is developing a plan of care for the hospitalized client with bulimia nervosa. The nursing instructor intervenes if the student documents which incorrect intervention in the plan? 1. Monitor intake and output. 2. Monitor electrolyte levels. 3. Observe for excessive exercise. 4. Check for the presence of laxatives and diuretics in the client’s belongings. Answer: 3 Rationale: Excessive exercise is a characteristic of anorexia nervosa, not a characteristic of clients with bulimia. Frequent vomiting, in addition to laxative and diuretic abuse may lead to dehydration and electrolyte imbalance. Monitoring for dehydration and electrolyte imbalance are important nursing actions. Option 3 is the only option that is not a characteristic of bulimia. Test-Taking Strategy: Use the process of elimination. Note the key word, incorrect, in the stem of the question. This word indicates a false response question and that you need to select the incorrect intervention. Options 1, 2, and 4 are similar and directly or indirectly infer concern about fluid and electrolyte balance. Option 3 is different from the other options. Review the characteristics associated with bulimia nervosa if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 237-238. 4. A nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal delirium. The nurse monitors for which of the following? 1. Hypertension, disorientation, hallucinations 2. Hypotension, ataxia, vomiting 3. Stupor, agitation, muscular rigidity 4. Hypotension, coarse hand tremor, agitation Answer: 1 Rationale: The symptoms associated with alcohol withdrawal typically are anxiety, insomnia, anorexia, hypertension, disorientation, visual or tactile hallucinations, changes in level of consciousness, agitation, fever, and delusions. Test-Taking Strategy: Use the process of elimination. Review each option carefully to ensure that all the symptoms are contained in the correct option. Eliminate options 2 and 4 first, knowing that hypertension rather than hypotension occurs. From the remaining options, recalling that the client who is stuporous is not likely to exhibit agitation will direct you to option 1. Review the symptoms associated with alcohol withdrawal if you had difficulty with this question. Level of Cognitive Ability: Analysis

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Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 491. 5. The spouse of a client admitted to the hospital for alcohol withdrawal says to the nurse, “I should get out of this bad situation.” The most helpful response by the nurse would be: 1. “I agree with you. You should get out of this situation.” 2. “What do you find difficult about this situation?” 3. “Why don’t you tell your husband about this?” 4. “This is not the best time to make that decision.” Answer: 2 Rationale: The most helpful response is the one that encourages the client to problem-solve. Giving advice implies that the nurse knows what is best and can also foster dependency. The nurse should not agree with the client nor should the nurse request that the client provide explanations. Test-Taking Strategy: Use therapeutic communication techniques. Eliminate option 3 because of the word “Why,” which should be avoided in communication. Eliminate option 1 because the nurse is agreeing with the client. Eliminate option 4 because this option places the client’s feelings on hold. Option 2 is the only option that addresses the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 88. 6. A nurse is caring for a client who is suspected of being dependent on drugs. Which question would be most appropriate for the nurse to ask when collecting data from the client regarding drug abuse? 1. "Why did you get started on these drugs?" 2. "How long did you think you could take these drugs without someone finding out?" 3. "How much do you use and what effect does it have on you?" 4. The nurse does not ask any questions because of fear that the client is in denial and will throw the nurse out of the room Answer: 3 Rationale: Whenever the nurse employs an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option 1 is incorrect because it is judgmental, off focus, and reflects the nurse's bias. Option 2 is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option 4 is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention. Test-Taking Strategy: Use the process of elimination and therapeutic communication techniques to

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answer the question. Option 3 is the statement that is nonjudgmental and direct. Review data collection of a client who is a drug abuser if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 298-299. 7. A client who has been drinking alcohol on a regular basis admits to having “a problem” and is asking for assistance with the problem. The nurse would encourage the client to attend which of the following community groups? 1. Al-Anon 2. Alcoholics Anonymous 3. Families Anonymous 4. Fresh Start Answer: 2 Rationale: Alcoholics Anonymous is a major self-help organization for the treatment of alcoholism. Option 1 is a group for families of alcoholics. Option 3 is for parents of children who abuse substances. Option 4 is for nicotine addicts. Test-Taking Strategy: Use the process of elimination. If you are unfamiliar with these support groups, note the relation between “drinking” in the question and “Alcoholics” in the correct option. Familiarize yourself with the purposes of specific support groups if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 299. 8. A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed hospital room. A newly admitted client will be assigned to this client’s room. Which client would be an appropriate choice as this client’s roommate? 1. A client with pneumonia 2. A client receiving diagnostic tests 3. A client who could benefit from the client’s assistance at mealtime 4. A client who thrives on managing others Answer: 2 Rationale: The client receiving diagnostic tests is an appropriate roommate. The client with anorexia is most likely experiencing hematological complications, such as leukopenia. Having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. The client with anorexia nervosa should not be put in a situation in which he or she can focus on the nutritional needs of others or be managed by others, because this may contribute to sublimation and suppression of their own hunger.

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Test-Taking Strategy: Use the process of elimination and note the key words, in a state of starvation. Recalling the characteristics and complications associated with anorexia nervosa will direct you to option 2. Review care of the client with anorexia nervosa if you have difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 236. 9. A client has been hospitalized and has participated in substance abuse therapy group sessions. On discharge, the client has consented to participate in Alcoholics Anonymous (AA) community groups. Which statement by the client would best indicate to the nurse that the client has well assimilated therapy session topics and coping response styles, and has processed information effectively for self-use? 1. “I know I’m ready to be discharged; I feel like I can say ‘no’ and leave a group of friends if they are drinking. No problem.” 2. “This group has really helped a lot. I know it will be different when I go home. But I’m sure that my family and friends will all help me like the people in this group have. They’ll all help me; I know they will. They won’t let me go back to my old ways.” 3. “I’m looking forward to leaving here; I know that I will miss all of you. So, I’m happy and I’m sad, I’m excited and I’m scared. I know that I have to work hard to be strong and that everyone isn’t going to be as helpful as you people.” 4 . “I’ll keep all my appointments and go to all my AA groups. I’ll do everything I’m supposed to. Nothing will go wrong that way.” Answer: 3 Rationale: In option 3, the client is expressing real concern and ambivalence about discharge from the hospital. The client also demonstrates reality in the statement. Option 1 indicates client denial. In option 2, the client is relying heavily on others. In option 4, the client is concrete and procedure-oriented; again, the client denies that “nothing will go wrong that way” if the client follows all the directions. Test-Taking Strategy: Use the process of elimination and select the option that identifies the most realistic client verbalization. This will direct you to option 3. Review care of the client with a substance abuse problem if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 302. 10. A nurse is assigned to care for a client at risk for alcohol withdrawal. The nurse monitors the client, knowing that the early signs of withdrawal will develop within how much time after cessation or reduction of alcohol intake?

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1. Within a few hours 2. In 7 days 3. In 14 days 4. In 21 days Answer: 1 Rationale: Early signs of alcohol withdrawal develop within a few hours after cessation or reduction of alcohol and peak after 24 to 48 hours. Test-Taking Strategy: Use the process of elimination and note the key word, early. This will assist in directing you to option 1. If you are unfamiliar with the manifestations associated with alcohol withdrawal, review this content. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, 491. 11. A nurse determines that the wife of an alcoholic client is benefiting from attending an AlAnon group when the nurse hears the wife say: 1. “My attendance at the meetings has helped me to see that I provoke my husband's violence." 2. “I no longer feel that I deserve the beatings my husband inflicts on me." 3. "I can tolerate my husband's destructive behaviors now that I know they are common in alcoholics." 4. "I enjoy attending the meetings because they get me out of the house and away from my husband." Answer: 2 Rationale: Al-Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain suggestions about successful behavioral changes. Option 2 is the healthiest response, because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control. The nonalcoholic partner should not feel responsible when the spouse loses control (option 1). Option 3 indicates that the wife remains codependent. Option 4 indicates that the group is being seen as an escape, not a place to work on issues. Test-Taking Strategy: Use the process of elimination and focus on the issue of the question, benefiting from attending an Al-Anon group. This will direct you to option 2. Review the purpose of this type of support group if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 506. 12. A female client with anorexia nervosa is a member of a support group. The client has verbalized that she would like to buy some new clothes but her finances are limited. Group

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members have brought some used clothes for the client to replace her old clothes. The client believes that the new clothes were much too tight, so she has reduced her calorie intake to 800 calories daily. The nurse identifies this behavior as: 1. Normal 2. Indicative of the client’s ambivalence 3. Evidence of the client’s altered and distorted body image 4. Regression Answer: 3 Rationale: Altered or distorted body image is a concern with clients with anorexia nervosa. Although the client may struggle with ambivalence and present with regressed behavior, the client’s coping pattern relates to the basic issue of distorted body image. The nurse should address this need in the support group. Test-Taking Strategy: Use the process of elimination. Focus on the information provided in the question to determine that the issue relates to a distorted body image. This will direct you to option 3. If you had difficulty with this question, review the characteristics associated with the client with anorexia nervosa. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, pp. 532-533. 13. A hospitalized client with a history of alcohol abuse tells the nurse, “I am leaving now. I have to go. I don’t want any more treatment. I have things that I have to do right away.” The client has not been discharged. In fact, the client is scheduled for an important diagnostic test to be performed in 1 hour. After discussing the client’s concerns with the client, the client dresses and begins to walk out of the hospital room. The appropriate nursing action is to: 1. Restrain the client until the physician can be reached. 2. Call security to block all exit areas. 3. Tell the client that they cannot return to this hospital again if they leave now. 4. Call the nursing supervisor. Answer: 4 Rationale: A nurse can be charged with false imprisonment if a client is made to wrongfully believe that they cannot leave the hospital. Most health care facilities have documents that the client is asked to sign, which relate to the client’s responsibilities when they leave against medical advice (AMA). The client should be asked to sign this document before leaving. The nurse should request that the client wait to speak to the physician before leaving but, if the client refuses to do so, the nurse cannot hold the client against his or her will. Restraining the client and calling security to block exits constitutes false imprisonment. Any client has a right to health care and cannot be told otherwise. Test-Taking Strategy: Use the process of elimination. Keeping the concept of false imprisonment in mind, eliminate options 1 and 2 because they are similar. Eliminate option 3, knowing that any client has a right to health care. Review the points related to false imprisonment if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 24-25. 14. A nursing student is asked to identify the characteristics of bulimia nervosa. The nursing instructor intervenes if the student identifies which incorrect characteristic of this disorder? 1. Enlarged parotid glands 2. Dental erosion 3. Electrolyte imbalances 4. Body weight well below ideal range Answer: 4 Rationale: Clients with bulimia nervosa may not initially appear to be physically or emotionally ill. They are often at or slightly below ideal body weight. On further inspection, the client demonstrates enlargement of the parotid glands with dental erosion and caries if the client has been inducing vomiting. Electrolyte imbalances are present. Test-Taking Strategy: Use the process of elimination and note the key word, incorrect. Focusing on the client’s diagnosis will direct you to option 4. Option 4 is a characteristic sign of anorexia nervosa, not bulimia nervosa. Review the characteristics of these disorders if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 237. 15. A nurse is caring for a client who has a history of opioid abuse and is monitoring the client for signs of withdrawal. Which clinical manifestations are associated with withdrawal from opioids? 1. Yawning, irritability, diaphoresis, cramps, and diarrhea 2. Tachycardia, hypertension, sweating, and marked tremors 3. Increased appetite, irritability, anxiety, and restlessness 4. Depressed feelings, high drug craving, fatigue, and agitation Answer: 1 Rationale: Opioids are central nervous system (CNS) depressants. Withdrawal effects include yawning, insomnia, irritability, rhinorrhea, diaphoresis, cramps, nausea and vomiting, muscle aches, chills, fever, lacrimation, and diarrhea. Withdrawal is treated by methadone tapering or medication detoxification. Option 1 identifies the clinical manifestations associated with withdrawal from opioids. Option 2 describes withdrawal from alcohol. Option 3 describes withdrawal from nicotine. Option 4 describes withdrawal from cocaine. Test-Taking Strategy: Focus on the issue of the question, the clinical manifestations associated with withdrawal from opioids. Recalling that opioids are central nervous system depressants will direct

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you to option 1. If you had difficulty with this question, review the manifestations associated with opioid withdrawal. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 498. 16. Select the appropriate interventions for caring for the client in alcohol withdrawal. ____Monitor vital signs. ____Provide stimulation in the environment. ____Maintain an NPO status. ____Provide reality orientation as appropriate. ____Address hallucinations therapeutically. Answers: Monitor vital signs. Provide reality orientation as appropriate. Address hallucinations therapeutically. Rationale: When the client is experiencing withdrawal of alcohol, the priority for care is to prevent the client from harming self or others. The nurse would provide a low-stimulation environment to maintain the client in as calm a state as possible. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake needs to be maintained. Test-Taking Strategy: Use therapeutic communication techniques and interventions to assist in selecting the correct interventions. Also, recalling the characteristics associated with alcohol withdrawal will assist in answering correctly. Review these interventions if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Ignatavicius, D., & Workman, M. (2006). Medical surgical nursing: Critical thinking for collaborative care (5th ed.). Philadelphia: W.B. Saunders, p. 101.