Chapter 19: Addiction
The nurse is leading a family therapy group with a client addicted to alcohol. Which statement made by the spouse indicates the need for additional education regarding alcoholism as a family illness?
A. "I have to call in sick for the client when the client is too hung over to go to work."
B. "Last time the client got arrested, I just let the client sit in jail."
C. "We have separated our finances so that I will not go broke."
D. "I take my kids with me to Al-anon meetings every week."
Answer: A
Rationale: One type of codependent behavior is called enabling, which is a behavior that seems helpful on the surface but actually perpetuates the substance use. Covering for the client when they are too hungover to work perpetuates addictive behaviors because it spares them from the natural consequences of the client's actions. Family attendance at Al-anon and support groups shows that the family understands the implications of the client's addictions for the family. Letting the client sit in jail and separating the family finances are healthy responses that assertively protect the family while allowing the client to experience the consequences of their actions.
The nurse is assisting a client with an eating disorder to accept their body image and use effective coping skills. Which will the nurse discuss with the client in relation to body acceptance and coping skills?
A. In order for you to develop coping skills, it is important to have had a supportive upbringing.
B. When body image is positive, you will develop better coping skills.
C. Being able to cope in healthy ways improves the ability to accept a realistic body image.
D. Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.
Answer: C
Rationale: When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.
A parent informs the nurse that they are concerned that the parent's child might suffer from attention-deficit/hyperactivity disorder (ADHD). The child can sit still, running all over the house, and having difficulty in school. Which is the best response by the nurse?
A. “From what you are describing, ADHD may be a possibility and we will refer you to a specialist for screening.”
B. “All children can be like that and it may be a disciplinary issue and not a symptom of ADHD.”
C. “Not all children do well in school and parents have a very high expectation of achievement.”
D. “You should be sure to talk to the health care provider about prescribing medication for treatment.”
Answer: A
Rationale: Although some of the characteristics of ADHD are described by the parent, screening tools are appropriate to use to get a definitive diagnosis. The nurse is responding in a generalized way when saying “all children.” Stating that it may be a disciplinary issue is stepping over the line of professional behavior and criticizing parenting styles. Medication as treatment prior to adequate screening is not an appropriate approach that is safe for the child.
A client with dementia gets angry and begins to yell at the nurse during mealtime in the dining area. Which is the best action by the nurse?
A. Administer antianxiety medication to the client.
B. Remove the client from the dining area until they have calmed down.
C. Step away from the client for 5 to 10 minutes and then return.
D. Inform the client that they are not to speak to someone in that manner.
Answer: C
Rationale: Time-away involves leaving clients for a short period and then returning to them to reengage in interaction. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on return. Medication for anxiety is not warranted at this time and may anger the client further at the attempt. The client does not need to be removed from the area since they are not harming anyone and they need the nutrition from their meal. Correcting the client at this point is futile since they will likely have no memory of the behavior to make the change.
A nurse is working with a couple seeking counseling for marital discord. The history indicates one of the clients was treated for substance use disorder 4 years ago and attends Alcoholics Anonymous (AA) meetings occasionally. Which statement made by the recovering client should alert the nurse for the need for further education?
A. "I still need to go to AA meetings even though I have been sober for years."
B. "After all these years, I just don't have the will power to stop if I started using again."
C. "My spouse gets upset when I hang out with my old buddies on the weekends."
D. "I wish I could be able to handle just one beer with dinner."
Answer: C
Rationale: Family members and friends should be aware that clients who begin to revert to old behaviors, return to substance-using acquaintances, or believe they can "handle myself now" are at high risk for relapse, and loved ones need to take action. An acknowledgment of the need for long-term recovery and accountability (such as AA) shows an understanding of the chronic nature of addictions. Stating "After all these years, I just don't have the will power to stop if I started using again" shows an understanding of the fact that even a small amount of alcohol would be a trigger for relapse. Stating "I wish I could be able to handle just one beer with dinner" implies the same. The client knows that one beer would be a trigger for relapse.
The nurse is creating a plan of care for a client with anorexia nervosa. Which nursing intervention is most likely to help the client to establish healthy eating patterns?
A. Leave the client alone to relax during meals.
B. Offer liquid protein supplements if the client is unable to complete a meal.
C. Observe the client for 30 minutes after all meals.
D. Weigh the client weekly in the same clothing at the same time of day.
Answer: B
Rationale: Nursing interventions designed to establish nutritional eating patterns include sitting with the client during meals and snacks, giving a liquid protein supplement to replace any food not eaten to ensure consumption of the total number of prescribed calories, adhering to treatment program guidelines regarding restrictions, observing the client following meals and snacks for 1 to 2 hours, weighing the client daily in uniform clothing, and being alert for attempts to hide or discard food or inflate weight.
The school nurse is talking with the parent of a 7-year-old child who is having difficulty in the classroom due to a diagnosis of attention-deficit/hyperactivity disorder (ADHD). The child is having difficulty paying attention, listening, and completing tasks. Which suggestion can the nurse give for improvement to the parent?
A. Allow the child to listen to music with headphones while completing class work.
B. Request that the child be seated in front of the teacher in the classroom.
C. Encourage the parent to increase the dosage of medication the child is taking.
D. Have the child do the majority of school work on a computer in the classroom.
Answer: B
Rationale: Managing the environment helps the child improve their ability to listen, pay attention, and complete tasks. A quiet place with minimal noise and distraction is desirable. At school, this may be a seat directly facing the teacher at the front of the room and away from the distraction of a window or door. Allowing the child to listen to music will be too distracting and will not allow the child to focus. Increasing the dosage of medication is a decision that will be made by the prescribing health care provider. The computer may be distracting to a child with ADHD, especially with games that are colorful and fast paced.
The nurse is performing an assessment for a client with early signs of dementia. The nurse asks the client what they ate for breakfast this morning. Which assessment data will the nurse obtain and document from this question?
A. Orientation
B. Food preferences
C. Recent memory
D. Remote memory
Answer: C
Rationale: The initial sign of dementia is memory loss for recent events that exceeds normal forgetfulness. Asking what the client ate for breakfast is not determining orientation, food preferences, or remote memory.
A client has been admitted to the inpatient unit after using inhalants. Upon assessment, the nurse finds the client with slurred speech and nystagmus. Which action is a priority at this time?
A. Apply seizure precautions.
B. Administer naloxone.
C. Administer activated charcoal.
D. Support the cardiorespiratory systems.
Answer: D
Rationale: There is no antidote or specific medication to treat inhalant toxicity. The priority action by the nurse is to support the cardiorespiratory systems. The use of inhalants can cause stupor and coma. Seizure precautions are not the priority since this may not occur with the client intoxicated with inhalants. Naloxone reverses the effects of opioid overdose but is not effective with inhalants. Activated charcoal is ineffective to alter the effects of the inhalants.
The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse identify when interacting with the client?
A. Careless
B. Outspoken
C. Defiant
D. Eager to please
Answer: D
Rationale: Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence, achievement oriented, dependable, eager to please, and seeking approval before their condition began. Parents describe clients as being "good, causing us no trouble" until the onset of anorexia. Likewise, clients with bulimia often are focused on pleasing others and avoiding conflict. These clients are often highly regimented, not careless. Overt defiance is unlikely because they may be eager to please. Clients are often evasive rather than outspoken when they are attempting to avoid ownership of their eating disorder.
A nurse is providing education to a group of parents who have children with attention-deficit/hyperactivity disorder (ADHD). Which information will the nurse include in the education? Select all that apply.
A. Placing your child on medication alone will be adequate treatment.
B. Take the time to learn how to rebuild a child's self-esteem.
C. Support groups can provide information and encouragement from others.
D. ADHD is not the fault of the parents or the child.
E. Children with ADHD do not qualify for special school services.
Answer: B, C, D
Rationale: Raising a child with ADHD is not a simple task, and the parents will require education and support. It is helpful for the parents to have a support group where they can receive encouragement from others and share experiences as well as what may be working for some children. Learning how to build a child’s self-esteem is an important part of treatment. The child with ADHD does not often feel good about themself and may get treated differently than other children from teachers and parents. There is no known specific cause of ADHD, and the nurse will encourage the parents not to blame themselves. Children with ADHD qualify for public school assistance in specialty services.
The nurse is caring for a client with dementia who has hallucinations and delusions. The client tells the nurse they cannot take a shower since they are waiting to go home. Which response by the nurse is best in this situation?
A. "It would be best if you just took your shower now."
B. "You seem anxious and upset."
C. "You have plenty of time to shower before it's time to go home."
D. "Why are you thinking you're going home?"
Answer: C
Rationale: This is an example of going along with, rather than correcting, the client's misperception so that the client can get on with the client's daily activities and not focus on being upset about not going home. Insisting on the shower without explanation or confronting the client about their mood and expectations will likely lead to more frustration.
The nurse suspects another nurse of substance use disorder while working in the long-term care facility. Which behavior(s) will the observing nurse report to the nurse manager? Select all that apply.
A. The clients are reporting a lack of pain control when the nurse is working.
B. The nurse administers narcotics and then goes to use the bathroom.
C. The observing nurse finds oral narcotics blister packs torn in the back.
D. The narcotic count is incorrect when the nurse ends the shift.
E. The nurse has poor hygiene practices and has an offensive body odor.
Answer: A, B, C, D
Rationale: There are several behaviors that a chemically impaired nurse may have that should be reported—frequent absenteeism, leaving the unit or going into a private area after administering a narcotic, damaged or torn packaging on narcotics, incorrect drug counts, excessive controlled substances listed as wasted or contaminated, and unusual behaviors. The nurse’s hygiene practices are not a criteria to report.
The nurse is talking with the parent of an adolescent with anorexia nervosa about how they interact at home. Which response(s) by the parent related to the history of the disorder correlates with anorexia? Select all that apply.
A. “We found that our child was having a problem with stealing.
B. “My child has a history over the last 2 years of cocaine use disorder.”
C. “My child will be graduating high school 2 years earlier than others.”
D. “You should see all of the achievements my child has and trophies.”
E. “My child has always been so “good” before the onset of the illness.
Answer: D, E
Rationale: Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence who are achievement-oriented, dependable, eager to please, and seeking approval before onset of the condition. Parents describe clients as being “good, causing us no trouble” until the onset of anorexia. Clients with bulimia often have a history of impulsive behavior such as substance use disorder and shoplifting as well as anxiety, depression, and personality disorders.
The parents of a child with attention-deficit/hyperactivity disorder (ADHD) express to the nurse, "We get so frustrated when our child never listens to us." Which parenting strategies will the nurse discuss with the parents? Select all that apply.
A. Use appropriate time-out strategies for behavior control.
B. Provide occasional rewards and consequences for behavior.
C. Give verbal reprimands for negative behavior.
D. Resist giving praise until fully compliant with requests.
E. Use a point system for positive and negative behavior.
Answer: A, C, E
Rationale: Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. Including parents in planning and providing care for the child with ADHD is important. When using time-out strategies for behavior consequences, the time should be appropriate for age and behavior exhibited. Behavior should be an expectation, and the child should not be rewarded for expected behavior since they may use it as a manipulative tool. The parents should use verbal reprimands and not physical punishments. Praise should be given for small or each step of completion and not only for completion of the task. Praise may go a long way toward goal completion. A point system is an effective method for goal achievement of optimal behavior, and the child will enjoy the small rewards for good behavior.
The nurse is caring for a client with Alzheimer disease. The nurse observes that the client's pacing and mumbling to themself that increase at mealtime and shift change. Which intervention will the nurse implement first?
A. Administer an antianxiety drug such as lorazepam at these times.
B. Explain the unit routine and the reasons for increased activity to the client.
C. Keep unit activity to a minimum.
D. Move the client to a quieter area during these times.
Answer: D
Rationale: The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent may be done but would not be the initial intervention. It is more realistic to change the client's location than to alter the overall activity on the unit. Depending on the client's cognition, explanations may be ineffective or frustrating.
The nurse is talking with a client that grew up in a home where both parents were alcoholics. Which behavior(s) does the nurse identify when assessing this client that correlate with this home life? Select all that apply.
A. Drinks alcohol to excess 3 days a week
B. Several trusting relationships with friends
C. Went back to college to complete a degree in nursing
D. Divorced 3 times with tumultuous relationships with spouses
E. States that they hang on to bad relationships due to fear of being alone
Answer: A, D, E
Rationale: Many people growing up in homes with parental alcoholism believe their problems will be solved when they are old enough to leave and escape the situation. They may begin to have problems in relationships such as maintaining a marriage, have low self-esteem, and have excessive fears of abandonment or insecurity as adults. Difficulty with problem-solving and using maladaptive coping mechanisms such as substance use. Going back to college and achieving goals and having several trusting friendships are not behaviors that are maladaptive and indicate parenteral alcohol use.
The nurse is creating a plan of care for a client diagnosed with bulimia nervosa that has just been admitted. Which immediate outcome(s) will the nurse assign for evaluation of effective care? Select all that apply.
A. The client will be free from self-inflicted harm to self.
B. The client will begin keeping a journal to deal with stress.
C. The client will express feelings in a non-food related way.
D. The client will verbalize feelings of guilt, anxiety, or anger within 4 days.
E. The client will verbalize a realistic body image.
Answer: A, B, D
Rationale: In the immediate phase after admission, the client will be assigned the outcome of safety since that is a priority of care and to prevent self-harm. Keeping a journal will be a way for the client to express themselves, especially if they are not prepared to verbalize these thoughts and feelings. The outcome of verbalization of anger, anxiety, and guilt is one of the first goals of verbalization. At this time the client will begin to work with staff about how to identify triggers. The client is not prepared at this point to express feelings in a non-food related way or realistic body image since these will be done in the stabilization phase.
The nurse is preparing to bring a child and their parents into the examination room to see the health care provider. Which are the best way(s) for the nurse to assess the child for attention-deficit/hyperactivity disorder (ADHD)? Select all that apply.
A. Directly observing the child
B. Reviewing the client's record
C. Interviewing the client's parents
D. Interviewing the client's teachers
E. Assessing the client in a group of peers
Answer: A, C, D, E
Rationale: During assessment, the nurse gathers information through direct observation and from the child's parents, day care providers (if any), and teachers. Assessing the child in a group of peers is likely to yield useful information because the child's behavior may be subdued or different in a focused one-to-one interaction with the nurse. Reviewing the client's record will not yield much assessment data. Reviewing the client's record provides useful data about the child's history, but this is not considered the nurse's own assessment data.
The nurse is performing a health history and physical assessment for a client whom the family members stated that the client is exhibiting new-onset confusion. Which data reported by the family member indicate the possible reason(s) the client is experiencing the confusion or delirium? Select all that apply.
A. The family reports the client has been drinking alcohol to excess.
B. The client is drinking very little fluids and has to be encouraged to drink water.
C. The client has broken out in hives and using diphenhydramine.
D. The client is only sleeping approximately 2 to 3 hours a night and up several times.
E. The client is using over-the-counter vitamins daily.
F. The client has just had the inside of the house painted.
Answer: A, B, C, D, F
Rationale: Because the causes of delirium are often related to dehydration, alcohol, or other drugs, the nurse obtains a thorough history of these areas. Information about drugs should include prescribed medications, alcohol, illicit drugs, and over-the-counter medications. Alteration in sleep patterns and lack of sleep may cause delirium. Antihistamines, such as diphenhydramine, may cause delirium, especially in the older adult population. Inhalants, such as exposure to pain, have the potential to cause delirium, but vitamins do not normally have this side effect.