Medications
On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:
A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.
A. avoid all products containing alcohol.
Rationale: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.
A client withdrawing from alcohol tells the nurse that he is worried about periodic hallucinations. What is the most appropriate intervention by the nurse?
A. Point out that the sensation doesn't exist.
B. Allow the client to talk about the experience.
C. Encourage the client to wash the body areas well.
D. Determine if the client has a cognitive impairment.
B.
Rationale: The client needs to talk about the periodic hallucinations to prevent them from becoming triggers to acting out behaviors and possible self-injury. The client's experience of sensory-perceptual alterations must be acknowledged; therefore, denying that the client's hallucinations exist isn't a helpful strategy. Determining if the client has a cognitive impairment and encouraging the client to wash the body areas well don't address the problem of periodic hallucinations.
Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16033-16036). Lippincott Williams & Wilkins. Kindle Edition.
A strong indicator of opioid toxicity is called the triad of symptoms, which consists of:
A. pinpoint pupils, depressed respiration, and coma.
B. vomiting, yawning, elevated blood pressure and pulse.
C. nausea, depressed respiration, and hallucinations.
D. Irritability, depressed respiration, and chronic pain.
A. pinpoint pupils, depressed respiration, and coma.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 305.
A young adult tells the nurse, "I have a new prescription for medical marijuana. I use it several times a day for my frequent muscle spasms." What information should the nurse provide first to this patient?
A. Guidance that the prescription should not be shared with peers.
B. Directions to weigh self once a week and maintain a log of the results.
C. Instructions about safety issues associated with driving or operating machinery.
D. Information about the potential for amotivational syndrome and memory problems.
C. Instructions about safety issues associated with driving or operating machinery.
Rationale: All of the options are correct, but safety is the nurse's first concern. Marijuana is a psychoactive substance. Effects include euphoria, sedation, perceptual distortions, and hallucinations; therefore driving or operating machinery may be hazardous.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 297.
A patient tells the nurse, "After many years, I finally quit smoking. Now I use e-cigarettes only." Which response should the nurse provide?
A. "Using e-cigarettes is now more socially acceptable than using traditional cigarettes."
B. "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals."
C. "Nicotine is a powerful addiction. Quitting smoking is a big step toward adopting a healthier lifestyle."
D. "I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke."
B. "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals."
Rationale: The nurse should educate the patient. E-cigarettes are advertised as safe; however, they contain nicotine as well as other hazardous chemicals.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 297.
What medications help individuals maintain sobriety based on making alcohol use unpleasant and reducing its reinforcing qualities. Select all that apply:
A. naltrexone (ReVia, Vivitrol)
B. acamprosate (Campral)
C. clonazepam (Klonopin)
D. carbamazepine (Tegretol)
E. disulfiram (Antabuse)
A, B, E
Rationale:
disulfiram (Antabuse) is used after an individual has been alcohol free/sober for a number of months to demonstrate his/her ability to remain abstinent. This drug is a motivational aid for people who want to stay sober.
naltrexone (ReVia, Vivitrol) reduces the desired pleasant feelings ("high) by blocking the release of endorphins r/t alcohol/opioid intake. Also, blocks drug cravings.
acamprosate (Campral) helps by reducing some of the unpleasant symptoms of abstinence such as anxiety, tension, and dysphoria, which can also cut down on the craving for the drug.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 304.
The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium?
A. Hypotension, ataxia, hunger
B. Stupor, lethargy, muscular rigidity
C. Hypotension, coarse hand tremors, lethargy
D. Hypertension, changes in level of consciousness, hallucinations
D. Hypertension, changes in level of consciousness, hallucinations
Rationale: Symptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, changes in level of consciousness, agitation, fever, and delusions
-Saunders NCLEX Ch. 70
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority?
A. Orient the client frequently to time, place, and person.
B. Offer fluids and nourishing diet as tolerated.
C. Implement seizure precautions.
D. Encourage participation in group therapy sessions.
C. Implement seizure precautions.
Rationale: The greatest risk to the client is injury. Implementing seizure precautions is the priority intervention.
-ATI Mental Health Ch. 18
What is the most important short-term goal for a client with a knowledge deficit about the effects of alcohol on the body?
A. Test blood chemistries daily.
B. Verbalize the results of substance use.
C. Talk to a pharmacist about the substance.
D. Attend a weekly aerobic exercise program.
B.
Rationale: It's important for the client to talk about the health consequences of the continued use of alcohol. Testing blood chemistries daily gives the client minimal knowledge about the effects of alcohol on the body and isn't the most useful information in a teaching plan. A pharmacist isn't the appropriate health care professional to educate the client about the effects of alcohol use on the body. Although exercise is an important goal of self-care, it doesn't address the client's knowledge deficit about the effects of alcohol on the body. CN: Safe, effective care environment;
Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16012-16017). Lippincott Williams & Wilkins. Kindle Edition.
The client's family member asks the nurse "what is considered heavy drinking for both men and women?" What is the nurse's best response?
A. "Heavy drinking for both male and females depends on the person's size, height, and weight."
B. "They can drink as much as they want until they feel tipsy."
C. "Heavy drinking for men is more than 4 drinks on any 1 day. As for women, it is more than 3 standard drinks on any 1 day."
D. "I would limit it to 2 drinks at most for the day."
C. "Heavy drinking for men is more than 4 drinks on any 1 day. As for women, it is more than 3 standard drinks on any 1 day."
Rationale: Heavy drinking is alcohol consumption that exceeds the recommended daily limits.
For men: More than 4 standard drinks on any 1 day, or more than 14 standard drinks in any 1 week. One night out with friends during which you drink three beers and a couple of shots would put you over the daily limit.
For women: More than 3 standard drinks on any 1 day, or more than 7 standard drinks in any 1 week. If you drink two medium-sized glasses of wine (8 oz.) every night after work, you are over the minute before you reach the weekend.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 296.
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol?
A. chlordiazepoxide
B. Buproprion
C. Disulfiram
D. Carbamazepine
C. Disulfiram
Rationale: The nurse should expect to administer disulfiram to help the client maintain abstinence from alcohol.
-ATI Mental Health Ch. 18
What are the three stages of alcohol withdrawal syndrome?
Minor, Moderate to Severe, and DTs (Delirium Tremens)
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 303.
The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care?
A. Ask the client why he starting taking illegal drugs.
B. Ask the client about the amount of drug use and its effect.
C. Ask the client how long he thought that he could take drugs without someone finding out.
D. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.
B. Ask the client about the amount of drug use and its effect.
Rationale: Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgemental and direct.
-Saunders NCLEX Ch. 70
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 and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take?
A. Call the nursing supervisor.
B. Call security to block all exit areas.
C. Restrain the client until the health care provider (HCP) can be reached.
D. Tell the client that the client cannot return to this hospital again if the client leaves now.
A. Call the nursing supervisor.
Rationale: Most health care facilities have documents that client is asked to sign relating to the client's responsibilities when the client leaves against medical advice. The client should be asked to wait to speak to the HCP before leaving and to sign the "against medical advice" document before leaving. If the client refuses to do so, the nurse cannot hold the client against the client's will. Therefore, in this situation, the nurse should call the nursing supervisor.
-Saunders NCLEX Ch. 70
The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-non group if the nurse hears the wife make which statement?
A. "I no longer feel that I deserve the beatings my husband inflicts on me."
B. "My attendance at the meetings has helped me to see that I provoke my husband's violence."
C. "I enjoy attending the meetings because they get me out of the house and away from my husband."
D. "I can tolerate my husband's destructive behavior now that I know they are common among alcoholics."
A. "I no longer feel that I deserve the beatings my husband inflicts on me."
Rationale: Al-Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavioral changes.
-Saunders NCLEX Chapter 70
A nurse teaches a patient diagnosed with an alcohol addiction about a new prescription for naltrexone. Which comment by the patient indicates the teaching was effective?
A. "This medicine will stop my cravings for alcohol."
B. "I should take this medication only when I feel cravings to drink alcohol."
C. "This medicine is one part of a bigger treatment plan to help me stay sober."
D. "I should not use products that contain alcohol, such as cough medicine and aftershave lotion."
C. "This medicine is one part of a bigger treatment plan to help me stay sober."
Rationale: Naltrexone(ReVia, Vivitrol) reduces the desired pleasant feelings related to alcohol or opioid intake and helps to reduce drug cravings. It is part of a total program for maintaining sobriety.
- Essentials of Psychiatric Mental Health Nursing Ch. 19, p. 304
A client has received chlordiazepoxide (Librium) to control the symptoms of alcohol withdrawal. The chlordiazepoxide has been ordered as needed. The nurse assesses the client and determines an additional dose of medication is needed when the client displays which symptoms? Select all that apply.
A. Tachycardia
B. Mood swings
C. Elevated blood pressure and temperature
D. Piloerection
E. Tremors
F. Increasing anxiety
A, C, E, and F.
Rationale: Benzodiazepines are usually administered based on elevations in heart rate, blood pressure, and temperature as well as on the presence of tremors and increasing anxiety. Mood swings are expected during the withdrawal period and are not an indication for further medication administration. Piloerection is not a symptom of alcohol withdrawal.
Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16639-16641). Lippincott Williams & Wilkins. Kindle Edition.
Alcohol abuse-induced thiamine deficiency can cause which of the following?
A. Agnosia
B. Wernicke-Korsakoff syndrome
C. Wolf-Hirschhorn syndrome
D. Lewy body dementia
B. Wernicke-Korsakoff syndrome
Rationale: Wernicke-Korsakoff syndrome is caused by a severe deficiency in thiamine, often seen in severe alcohol dependency. It is characterized by visual disturbances, ataxia, and altered consciousness. Wolf-Hirschhorn syndrome is a genetic disorder causing developmental disability and may involve seizures. Lewy body dementia is associated with Parkinson's disease. Agnosia is a neurological disorder causing impaired ability to process sensory information.
Prolonged alcohol abuse can result in a severe deficiency in thiamine, or vitamin B1 by reducing dietary thiamine intake, impairing gastrointestinal absorption of thiamine, and causing impaired thiamine utilization in cells. Note that individuals who partake in prolonged alcohol abuse may have various other dietary deficiencies.
-https://www.varsitytutors.com/nclex-help/alcohol-and-drug-abuse
A nurse suggests to a client struggling with alcohol addiction that keeping a journal may be helpful. The goal of this nursing intervention is to help the client do what?
A. Identify stressors and responses to them.
B. Understand the diagnosis.
C. Help others by reading the journal to them.
D. Develop an emergency plan for use in a crisis.
A.
Rationale: Keeping a journal enables the client to identify problems and patterns of coping. From this information, the difficulties the client faces can be addressed. A journal isn't necessarily kept to promote better understanding of the client's illness, but it helps the client understand himself better. Journals aren't read to other people unless the client wants to share a particular part. Journals aren't typically used for identifying an emergency plan for use in a crisis.
Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16107-16110). Lippincott Williams & Wilkins. Kindle Edition.
31. A client recovering from alcohol abuse tells the nurse, "I get nothing out of Alcoholics Anonymous (AA) meetings." What is the best response by the nurse?
A. " What were you told about going to AA meetings?"
B. " What do you want to get out of the AA meetings?"
C. " When do you think you'll stop going to the meetings?"
D. " Do you think you can control what happens in a meeting?"
B.
Rationale: This response puts some of the responsibility for staying sober on the client and encourages the client to take a more active role. Asking what the client was told about AA meetings opens up a discussion that allows the client to continue to discuss disappointments rather than taking a proactive stand to support the value of AA meetings. The third option condones the client's desire to stop going to the meetings. The fourth option changes the issue from being responsible for staying sober to focusing on what the client can't control.
Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16149-16152). Lippincott Williams & Wilkins. Kindle Edition.
The nurse administers bromocriptine (Parlodel) to Bryan who is undergoing detoxification for amphetamine abuse. The rationale for this medication is to:
A. Aid in GABA inhibition.
B. Prevent norepinephrine excess.
C. Restore depleted dopamine levels.
D. Treat psychotic symptoms.
C. Restore depleted dopamine levels.
Rationale: Amphetamine abuse depletes the neurotransmitter dopamine. When withdrawing from amphetamines, dopamine depletion causes depression, insomnia, and intense craving for the drug. Bromocriptine (Parlodel) is a dopamine agonist that will help restore this neurotransmitter. GABA inhibition, prevention of norepinephrine excess, and treatment of psychotic symptoms are incorrect rationales for the use of this medication.
https://nurseslabs.com/nclex-exam-psychiatric-nursing-substance-related-disorders-15-items/
Select the appropriate interventions for caring for the client in alcohol withdrawal. Select all that apply:
A. Monitor vital signs
B. Provide stimulation in the environment
C. Maintain NPO status
D. Provide reality orientation as appropriate
E. Address hallucinations therapeutically
A, D, E
Rationale: When the client is experiencing withdrawal of alcohol, the priority of care is to prevent the client from harming himself or others. The nurse would provide a low stimulating environment to maintain the client in as calm a state as possible. The nurse would monitor 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.
A nurse is using the CIWA scale while assessing a client who came to the med-surg unit due to alcohol withdrawal. The patient has mild nausea, moderately anxious, fidgety and restless, no sweat, moderate tremors, a&o x 4, no tactile, visual, and auditory disturbances present, and has a severe headache. What is their CIWA score?
15
Mild nausea = 1, moderately anxious = 4, fidgety and restless = 4, no sweat = 0, moderate tremors = 4, a&o x 4 = 0, no tactile, visual, and auditory disturbances present = 0, mild headache = 2. Total of 15.
Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply.
A. Monitor vital signs.
B. Provide a safe environment.
C. Address hallucinations therapeutically.
D. Provide stimulation in the environment.
E. Provide reality orientation as appropriate.
F. Maintain NPO status.
A, B, C, E
Rationale: When the client is experiencing withdrawal from alcohol, the priority for care is to prevent the client from harming self or others. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would provide a low-stimulation environment to maintain the client in as calm a state as possible. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional fluid intake need to be maintained.
-Saunders NCLEX Ch. 70
The client has been hospitalized and is participating in a substance abuse therapy group sessions. On discharge, the client has consented to participate in AA community groups. Which statement by the client best indicates that the client has developed effective coping response styles and has processed information effectively for self use?
A. "I know I’m ready to be discharged. I feel I can say 'no' and leave a group of friends if they are drinking…'No Problem.’"
B. "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."
C. "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."
D. "I'll keep all my appointments; go to all my AA groups; I’ll do everything I’m supposed to… Nothing will go wrong that way."
C. "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."
Rationale:
In the defense mechanism of denial the person denies reality. Option 1 identifies denial. In option 2 the client is relying heavily on others, and the client’s focus of control is external. In option 4 the client is concrete and procedure oriented; again the client identifies that “Nothing will go wrong that way” if the client follows all the directions. In option 3 the client is expressing real concern and ambivalence about discharge from the hospital. The client also demonstrates reality in that statement.