26.
Which of the following approaches is most appropriate to use with a client diagnosed with a narcissistic personality disorder when discrepancies exist between what the client states and what actu- ally exists?■ 1. Limit setting.
■ 2. Supportive confrontation.
■ 3. Consistency.
■ 4. Rationalization.
27.
The client with histrionic personality disor- der is melodramatic and responds to others and situ- ations in an exaggerated manner. The nurse should recommend which of the following activities for this client?■ 1. Party planning.
■ 2. Music group.
■ 3. Cooking class.
■ 4. Role-playing.
28.
When assessing a hospitalized client diag- nosed with Major Depression and BorderlinePersonality Disorder, the nurse should ask the client about which of the following fi rst?
■ 1. Access to pills and weapons.
■ 2. Suicidal plans.
■ 3. Suicidal thoughts.
■ 4. Seriousness of the client’s intent to die.
The Client with an Alcohol-Related
32.
An intoxicated client is admitted to the hospital for alcohol withdrawal. Which of the following should the nurse do to help the client become sober?■ 1. Give the client black coffee to drink.
■ 2. Walk the client around the unit.
■ 3. Have the client take a cold shower.
■ 4. Provide the client with a quiet room to sleep in.
33.
The client is admitted to the hospital for alcohol detoxifi cation. Which of the following interventions should the nurse use? Select all that apply.■ 1. Taking vital signs.
■ 2. Monitoring intake and output.
■ 3. Placing the client in restraints as a safety mea- sure.
■ 4. Reinforcing reality if the client is disoriented or hallucinating.
■ 5. Explaining to the client that the symptoms of withdrawal are temporary.
34.
A client was discharged from an alcohol rehabilitation program on clonazepam (Klonopin) 0.5 mg TID. Several months later he reports having insomnia, shakiness, sweating and one seizure. The nurse should fi rst ask the client if he:■ 1. Has been drinking alcohol with the Klonopin.
■ 2. Has developed tolerance to the Klonopin and needs to increase the dose.
■ 3. Has stopped taking the Klonopin suddenly.
■ 4. Is having a panic attack and needs to take an extra Klonopin.
35.
A client is entering the chemical dependency unit for treatment of alcohol dependency. Which of the client’s possessions should the nurse place in a locked area?■ 1. Toothpaste.
■ 2. Dental fl oss.
■ 3. Shaving cream.
■ 4. Antiseptic mouthwash.
36.
A client is entering rehabilitation for alco- hol dependency as an alternative to going to jail for multiple DUI’s (driving under the infl uence).While obtaining the client’s history, the nurse asks about the amount of alcohol he consumes daily. He responds, “I just have a few drinks with the guys after work.” Which of the following responses by the nurse is most therapeutic?
■ 1. “That’s what all the clients here say at fi rst.”
■ 2. “Then you should have had a designated driver for yourself.”
■ 3. “I guess you just can’t handle a few drinks.”
■ 4. “You say you have a few drinks, but you have multiple arrests.”
30.
A client known to have alcohol dependence is admitted to the emergency department with a temperature of 99° F, a pulse of 110, respirations of 26, and blood pressure of 150/98. The blood alcohol level is 0.25%, three times the legal limit.Now the client is becoming belligerent and unco- operative. In which order from fi rst to last should the following nursing and medical orders be implemented?
2. Draw blood for a magnesium level.
3. Take vital signs every 15 minutes.
4. Place client in a quiet room with dimmed lights.
1. Administer lorazepam (Ativan) 2 mg I.M.
31.
A client has been admitted to the emergency department with alcohol withdrawal delirium. The nurse is assessing the client for signs of withdrawal.At 9 a.m. on 10/25, the nurse notes that the client is confused. His vital signs are T = 99° F, P = 50, R = 10, and BP = 100/60. The nurse compares these fi ndings to the nurses’ progress notes from admis- sion 24 hours ago (see below). What should the nurse do fi rst?
■ 1. Contact the physician.
■ 2. Increase the rate of the I.V. infusion.
■ 3. Attempt to arouse the client.
■ 4. Administer magnesium sulfate.
Progress Notes
Date Time Progress Notes 10/24/07 09:00 pm T = 99° F; P = 110; R = 18;
BP = 140/90; Client has I.V. D5W keep open rate started; Valium administered as ordered.
Client oriented × 3.
10/25/07 01:00 am T = 99.2° F; P = 90; R = 14;
BP = 130/80; Client resting.
10/25/07 05:00 am T = 99° F; P = 70; R = 14;
BP = 126/80; Client oriented × 3.
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42.
A client is entering the alcohol treatment program for the fourth time in 5 years. Which of the following statements by the nurse will be most help- ful to the client?■ 1. “I hope you are serious about maintaining your sobriety this time.”
■ 2. “I’m Maria, a nurse here. I don’t know you from past attempts but you’ll get it right this time.”
■ 3. “I know someone who was successful after the fi fth program.”
■ 4. “I’m Maria, a nurse in the program. The staff and I will help you through the program.”
43.
The wife of a client with alcohol dependency tells the nurse, “I’m tired of making excuses for him to his boss and coworkers when he can’t make it into work. I believe him every time he says he’s going to quit.” The nurse recognizes the wife’s statement as indicating which of the following behaviors?■ 1. Helpfulness.
■ 2. Self-defeat.
■ 3. Enabling.
■ 4. Masochism.
44.
Which of the following statements by the nurse participating in a group confrontation of a coworker is most helpful in reducing the coworker’s denial about alcohol being a problem?■ 1. “Your behavior is unprofessional.”
■ 2. “As a nurse you should have sought help earlier.”
■ 3. “Nurses are the worst when it comes to ask- ing for help.”
■ 4. “You have alcohol on your breath.”
45.
The husband of a nurse who is being con- fronted by a group about her problem with alcohol asks the nurse acting as the group leader what he should say to his wife during the meeting. The nurse leader directs the husband to use which of the following statements to facilitate his wife’s entrance into treatment?■ 1. “The children and I want you to get help.”
■ 2. “If your parents were alive, they would be extremely disappointed in you.”
■ 3. “Either you get help or the kids and I will move out of the house.”
■ 4. “You need to enter treatment now or be a drunk if that’s what you want.”
46.
A nurse working in an alcohol rehabilitation program is teaching staff how to give clients con- structive feedback. Which of the following state- ments given as an example illustrates that the staff member understands the nurse’s teaching regarding the use of constructive feedback?■ 1. “I think you’re a real con artist.”
■ 2. “You’re dominating the conversation.”
■ 3. “You interrupted Terry twice in 4 minutes.”
■ 4. “You don’t give anyone a chance to fi nish talking.”
37.
While admitting a client to the alcohol treat- ment program, the nurse asks the client how long she’s been drinking, how much she’s been drinking, and when she had her last drink. The client replies that she has been drinking about a liter of vodka a day for the past week and her last drink was about an hour ago. This information helps the nurse to determine which of the following?■ 1. The severity of the disease.
■ 2. The severity of withdrawal symptoms.
■ 3. The possibility of alcoholic hallucinosis.
■ 4. The occurrence of delirium tremens.
38.
The client is feeling better as the symptoms of alcohol withdrawal abate. She refuses infor- mation about alcohol rehabilitation and states,“I don’t have a problem. I’ll never drink like that again. I learned my lesson this time. I guess I’ll just have to switch to beer or wine.” The nurse should respond by:
■ 1. Discussing how alcohol has gotten her into trouble.
■ 2. Explaining the effects of drinking on her family.
■ 3. Urging her to attend Alcoholics Anonymous meetings.
■ 4. Telling her about the physiologic damage that can result.
39.
A client who is experiencing alcohol with- drawal exhibits tremors, diaphoresis, and hyperac- tivity. Blood pressure is 190/87 mm Hg and pulse is 92 bpm. Which of the following medications should the nurse expect to administer?■ 1. Haloperidol (Haldol).
■ 2. Lorazepam (Ativan).
■ 3. Benztropine (Cogentin).
■ 4. Naloxone (Narcan).
40.
Which of the following assessments provides the best information about the client’s physiologic response and the effectiveness of the medication prescribed specifi cally for alcohol withdrawal?■ 1. Nutritional status.
■ 2. Evidence of tremors.
■ 3. Vital signs.
■ 4. Sleep pattern.
41.
A client who had been drinking heavily over the weekend could not remember specifi c events of where he had been or what he had done. The nurse interprets this information as indicating that the cli- ent experienced which of the following conditions?■ 1. Blackout.
■ 2. Hangover.
■ 3. Tolerance.
■ 4. Delirium tremens.
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53.
Which of the following client statements indicates an understanding of the signs of alcohol relapse?■ 1. “I know I can stay dry if my wife keeps alco- hol out of the house.”
■ 2. “Stopping Alcoholics Anonymous (AA) and not expressing feelings can lead to relapse.”
■ 3. “I’ll have my sponsor at AA keep the list of symptoms for me.”
■ 4. “If someone tells me I’m about to relapse, I’ll be sure to do something about it.”
54.
The client sees no connection between her liver disorder and her alcohol intake. She believes that she drinks very little and that her family is mak- ing something out of nothing. The nurse interprets these behaviors as indicative of the client’s use of which of the following defense mechanisms?■ 1. Denial.
■ 2. Displacement.
■ 3. Rationalization.
■ 4. Reaction formation.
55.
A client with alcohol dependency is pre- scribed a B-complex vitamin. The client states,“Why do I need a vitamin? My appetite is just fi ne.”
Which of the following responses by the nurse is most appropriate?
■ 1. “Your doctor wants you to take it for at least 4 months.”
■ 2. “You’ve been drinking alcohol and eating very little.”
■ 3. “The vitamin is a nutritional supplement important to your health.”
■ 4. “The amount of vitamins in the alcohol you drink is very low.”
56.
Which of the following foods should the nurse eliminate from the diet of a client in alcohol withdrawal?■ 1. Milk.
■ 2. Regular coffee.
■ 3. Orange juice.
■ 4. Eggs.
57.
A client with alcohol dependency has peripheral neuropathy. The nurse should develop a teaching plan that emphasizes:■ 1. Washing and drying the feet daily.
■ 2. Massaging the feet with lotion.
■ 3. Trimming the toenails carefully.
■ 4. Avoiding use of an electric blanket.
47.
A client ashamedly tells the nurse that he hit his wife while intoxicated and asks the nurse if his wife will ever forgive him. The nurse should reply to the client by saying:■ 1. “Perhaps you could ask her and fi nd out.”
■ 2. “That’s something you can explore in family therapy.”
■ 3. “It would depend on how much she really cares for you.”
■ 4. “You seem to have some feelings about hitting your wife.”
48.
While meeting with the nurse, a client’s wife states, “I don’t know what else to do to make him stop drinking.” The nurse should refer the wife to which of the following organizations?■ 1. Alateen.
■ 2. Al-Anon.
■ 3. Employee assistance program.
■ 4. Alcoholics Anonymous.
49.
Which of the following nursing actions is contraindicated for the client who is experiencing severe symptoms of alcohol withdrawal?■ 1. Helping the client walk.
■ 2. Monitoring intake and output.
■ 3. Assessing vital signs.
■ 4. Using short, concrete statements.
50.
Which of the following client statements indicates to the nurse that the client needs further teaching about disulfi ram (Antabuse)?■ 1. “I can drink one or two beers and not get sick while on Antabuse.”
■ 2. “I can take Antabuse at bedtime if it makes me sleepy.”
■ 3. “A metallic or garlic taste in my mouth is normal when starting on Antabuse.”
■ 4. “I’ll read the labels on cough syrup and mouthwash for possible alcohol content.”
51.
While receiving disulfi ram (Antabuse) therapy, the client becomes nauseated and vomits severely. Which of the following questions should the nurse ask fi rst?■ 1. “How long have you been taking Antabuse?”
■ 2. “Do you feel like you have the fl u?”
■ 3. “How much alcohol did you drink today?”
■ 4. “Have you eaten any foods cooked in wine?”
52.
The expected outcome for using thiamine for a client being treated for an alcohol addiction is to:■ 1. Prevent the development of Wernicke’s encephalopathy.
■ 2. Decrease clients’ withdrawal symptoms.
■ 3. Aid clients in regaining their strength sooner.
■ 4. Promote elimination of alcohol from the body faster.
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61.
A client is to be discharged from an alcohol rehabilitation program. Which of the following should the nurse emphasize in the discharge plan as a priority?■ 1. Supportive friends.
■ 2. A list of goals.
■ 3. Family forgiveness.
■ 4. Follow-up care.
62.
The client is to be discharged from the hos- pital after a safe, medically supervised withdrawal from alcohol. Which of the following outcomes indicate client readiness for an outpatient alcohol treatment program? Select all that apply.■ 1. The client states the need to cut down on his alcohol intake.
■ 2. The client verbalizes the damaging effects of alcohol on his body.
■ 3. The client plans to attend Alcoholics Anony- mous meetings.
■ 4. The client takes naltrexone (ReVia) daily.
■ 5. The client says he is indestructible.
63.
A client diagnosed with Major Depression and Substance Dependence is being admitted to the Dual Diagnosis Unit. In explaining the focus of this program, the nurse should tell the client?■ 1. The addiction will be treated fi rst, then the depression.
■ 2. The depression with be treated fi rst, then the addiction.
■ 3. There will be simultaneous treatment of the addiction and depression.
■ 4. As the addiction is treated, the depression will clear up on its own.
64.
While caring for a client who has a dual diag- nosis of bipolar disorder and alcohol dependency, which of the following areas is the priority for daily assessment?■ 1. Sleep pattern.
■ 2. Mental status.
■ 3. Eating habits.
■ 4. Self-care ability.
65.
A client diagnosed with schizophrenia and alcohol abuse decides to drink alcohol with his bud- dies. The nurse interprets this behavior, recognizing which of the following as an underlying dynamic of the client’s alcohol use?■ 1. The decision to use alcohol is a wish to feel accepted by others.
■ 2. The decision to drink increases the client’s guilt and shame.
■ 3. The client abused alcohol before developing a mental illness.
■ 4. The client is compelled to drink because of cognitive diffi culties.
58.
A client is experiencing alcohol withdrawal.He wakes up and screams, “There’s something crawling under my skin. Help me.” In which order, from fi rst to last, should the following nursing actions be done?
2. Administer a dose of lorazepam (Ativan) depending on the severity of the withdrawal symptoms.
3. Assess the client for other withdrawal symptoms.
4. Take the client’s vital signs
5. Chart the details of the episode on the electronic health record
1. Remind the client that he is having withdrawal symptoms and that these will be treated.
59.
Which of the following measures should the nurse include in the plan of care for a client with alcohol withdrawal delirium?■ 1. Using restraints continuously.
■ 2. Touching the client before saying anything.
■ 3. Remaining with the client when she is con- fused or disoriented.
■ 4. Informing the client about alcohol treatment programs.
60.
Which of the following is an accurateresponse when a client asks the nurse about require- ments to become a member of Alcoholics Anony- mous (AA)?
■ 1. “You must be sober for at least a month before joining.”
■ 2. “AA is open to anyone who wants sobriety.”
■ 3. “The members will interview you and decide if you can join the group.”
■ 4. “AA requires daily attendance at meetings.”
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69.
A client is brought to the emergency depart- ment by a friend who states, “He’s been using a lot of heroin until he ran out of money about 2 days ago.” The nurse judges the client to be in opioid withdrawal if he exhibits which of the following?Select all that apply.
■ 1. Rhinorrhea.
■ 2. Diaphoresis.
■ 3. Piloerection.
■ 4. Synesthesia.
■ 5. Formication.
70.
An unconscious client in the emergency department is given I.V. naloxone (Narcan) due to an overdose of heroin. Which of the following would indicate a therapeutic response to the Narcan?Select all that apply.
■ 1. Decreased pulse rate.
■ 2. Warm skin.
■ 3. Dilated pupils.
■ 4. Increased respirations.
■ 5. Consciousness.
71.
Which of the following should the nurse expect to assess for a client who is exhibiting late signs of heroin withdrawal?■ 1. Vomiting and diarrhea.
■ 2. Yawning and diaphoresis.
■ 3. Lacrimation and rhinorrhea.
■ 4. Restlessness and irritability.
72.
After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following?■ 1. Cerebral edema.
■ 2. Kidney failure.
■ 3. Seizure activity.
■ 4. Respiratory depression.
73.
When teaching a client who is to receive methadone therapy for opioid addiction, the nurse should instruct the client that methadone is useful primarily for which of the following reasons?■ 1. It is not an addictive substance.
■ 2. A maintenance dose is taken twice a day.
■ 3. The client will no longer be addicted to opi- oids.
■ 4. The client may work and live normally.
74.
A client states to the nurse, “I’m not going to any more Narcotics Anonymous meetings. I felt out of place there.” Which of the following responses by the nurse is best?■ 1. “Try attending a meeting at a different loca- tion; you may feel more comfortable there.”
■ 2. “Maybe it just wasn’t a good day for you.
Everybody has bad days now and then.”
■ 3. “Perhaps you weren’t paying close enough attention to what they were saying.”
■ 4. “Sometimes the meetings can seem like a waste of time, but you need to attend to stay clean.”