Question 1

A client with a history of cocaine abuse exhibits behavior changes following return from an inpatient treatment facility. The nurse anticipates that the physician will order which test?

Accepted Answer

Answer reason: A urine drug screen is the standard, rapid, noninvasive test used to detect recent cocaine use (via metabolites) and is commonly ordered when symptoms suggest intoxication or recurrence of use. This result guides immediate safety planning, monitoring, and treatment decisions in the psychiatric setting. Antibody, glucose, and hepatic screening do not directly verify recent cocaine ingestion and are less targeted for explaining sudden behavior change in this context.

Question 2

A client who uses cocaine denies that drug use is a problem. What is the best intervention by the nurse?

Accepted Answer

Answer reason: Clients in denial are typically in an early stage of change, so motivational interviewing focuses on exploring discrepancies and mixed feelings rather than persuading or lecturing. Highlighting ambivalence helps the client verbalize both perceived benefits and harms of cocaine use, which increases insight and readiness to consider change. This approach is nonjudgmental and supports autonomy, reducing resistance that often escalates when the nurse tries to “prove” the problem. Repeating drug facts tends to create defensiveness and does not effectively move a client from denial toward contemplation. Open-ended questions are helpful, but the most targeted best intervention here is to bring out and reflect ambivalence.

Question 3

A nurse is caring for a client addicted to heroin who is experiencing withdrawal symptoms. The nurse is aware that the withdrawal symptoms may be affected by which factor?

Accepted Answer

Answer reason: Ego strength reflects a client’s ability to tolerate distress, use adaptive defenses, and maintain behavioral control when experiencing intense discomfort and cravings, which can change the intensity and manageability of withdrawal symptoms. In contrast, liver and kidney function more directly affect metabolism/elimination of many drugs, but opioid withdrawal severity is primarily driven by neuroadaptation and time since last use rather than organ clearance. Seizure history is more relevant to alcohol/benzodiazepine withdrawal risk, since opioid withdrawal is typically not life-threatening and does not characteristically cause seizures.

Question 4

Clients unlikely to abstain from alcohol are not appropriate candidates for treatment with disulfiram (Antabuse), nor are clients with?

Accepted Answer

Answer reason: Disulfiram works by blocking aldehyde dehydrogenase, causing acetaldehyde accumulation if alcohol is consumed, which can trigger flushing, hypotension, tachycardia, chest pain, dysrhythmias, and even cardiovascular collapse. Patients with significant underlying cardiac disease are at higher risk of life-threatening complications from this reaction, making the medication unsafe. A sedentary occupation and latex allergy are unrelated to the drug’s mechanism or key contraindications. While liver disease is also a concern due to hepatotoxicity risk, the most clearly dangerous contraindication here is substantial heart disease because the disulfiram–alcohol reaction directly stresses the cardiovascular system.

Question 5

What is the most important short-term goal for a client with a knowledge deficit about the effects of alcohol on the body?

Accepted Answer

Answer reason: Short-term goals for a knowledge deficit focus on immediate evidence that learning has occurred, commonly demonstrated by the client accurately describing cause-and-effect and personal impact. Having the client articulate the consequences of alcohol use (physical, psychological, and social) directly evaluates understanding and insight and can increase readiness for behavior change. Daily lab testing is a monitoring intervention rather than a learning outcome and is not universally indicated for all clients. Talking to a pharmacist or starting exercise may be beneficial health behaviors but are indirect, longer-term, and do not best validate that the knowledge gap about alcohol’s bodily effects has been addressed.

Question 6

A client tells the nurse, “I have been drinking ever since they told me I had learning disabilities.” How does the nurse interpret this response?

Accepted Answer

Answer reason: The core principle is that substance use can be a maladaptive coping strategy used to reduce distressing emotions or perceived deficits. The client links onset of drinking directly to the stressful diagnosis, suggesting alcohol is being used to manage feelings such as anxiety, shame, or low self-esteem. This interpretation is therapeutic and nonjudgmental, aligning with how nurses assess triggers and functions of substance use. Labeling it as an “excuse” is judgmental and does not reflect clinical assessment, and predicting inability to stop is an unsupported conclusion from the single statement.

Question 7

The nurse is preparing a client with the diagnosis of alcohol dependency for discharge from the hospital. What is the most important goal for the client?

Accepted Answer

Answer reason: Sustained recovery from alcohol dependence requires recognizing triggers, building coping skills, and creating a concrete plan for high-risk situations after discharge. Discharge is a transition period with elevated relapse risk, so the priority goal is to equip the client with strategies such as avoiding cues, using support systems (e.g., AA/sponsor), and having an action plan if cravings occur. Controlled or “social” drinking is generally not a realistic or safe goal for dependence due to loss of control and high relapse potential. Grieving losses can be therapeutically important but is secondary to establishing immediate safety and maintenance of abstinence in the community.

Question 8

The nurse anticipates that a client undergoing nicotine withdrawal may make which statement?

Accepted Answer

Answer reason: ” Nicotine withdrawal commonly produces irritability, restlessness, dysphoric mood, and difficulty concentrating due to abrupt loss of nicotine’s stimulant/reinforcing effects on the CNS. A patient describing feeling generally unwell and unusually grouchy aligns with these expected withdrawal manifestations. Visual hallucinations are not a typical feature of nicotine withdrawal and should prompt assessment for another substance, delirium, or a primary psychotic disorder. Yawning is more characteristic of opioid withdrawal rather than nicotine cessation.

Question 9

The nurse is caring for a client who uses cocaine and has been admitted to an intensive outpatient rehabilitation program. It is most important for the nurse to assess the client for which finding?

Accepted Answer

Answer reason: In an outpatient rehab setting, identifying these symptoms promptly helps the nurse determine immediate safety needs, level of monitoring, and whether a higher level of care is required. GI upset and blurred vision are less characteristic as priority hallmark findings compared with stimulant-induced psychotic symptoms. Increased appetite is more typical of withdrawal “crash” states and is generally less urgent than assessing for altered perception that may signal intoxication-related psychosis.

Question 10

The nurse determines further teaching about nutrition is necessary when an alcoholic client makes which statement?

Accepted Answer

Answer reason: Alcohol use disorder commonly leads to poor intake, malabsorption, and vitamin deficiencies, so nutrition teaching emphasizes adequate calories and regular, balanced meals across the day. Limiting intake to one meal increases risk of continued malnutrition, hypoglycemia, and inadequate protein and micronutrient repletion during recovery. Clients are typically encouraged to consume small, frequent meals/snacks that are nutrient-dense to improve tolerance and restore stores. Vitamin/mineral supplementation (especially thiamine and folate) is often appropriate, making that statement consistent with expected teaching. Broadly avoiding fat is not the key corrective teaching point compared with ensuring sufficient overall intake.

Question 11

A young, depressed adult woman with a history of alcohol abuse is admitted to the hospital after a motor vehicle accident. The nurse performs the admission assessment of the client and anticipates that the history will include which of the following?

Accepted Answer

Answer reason: A history of sexual abuse can contribute to depression, maladaptive coping, and substance use initiation or escalation. In contrast, “defiant responses” is nonspecific and not a typical anticipated historical antecedent, and “infertility” is not a characteristic history element tied to alcohol abuse in a general screening sense. While alcohol misuse can cause cognitive impairment, “memory loss” describes a possible complication (e.g., blackouts) rather than a commonly anticipated predisposing life history factor in this context.

Question 12

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?

Accepted Answer

Answer reason: Journaling is a coping/relapse-prevention tool that increases insight into triggers and the client’s emotional, cognitive, and behavioral patterns surrounding alcohol use. By tracking situations, feelings, cravings, and outcomes, the client can recognize high-risk stressors and typical responses, which supports planning healthier coping strategies. Understanding a diagnosis is psychoeducation but is not the primary therapeutic purpose of journaling as an intervention. A crisis plan can be helpful in some settings, but journaling more directly targets day-to-day trigger awareness and self-monitoring that underpin sustained recovery.

Question 13

A client addicted to alcohol is scheduled to begin individual therapy with the nurse. What is the most important nursing intervention for the client?

Accepted Answer

Answer reason: Alcohol use disorder is commonly maintained by avoidance or suppression of affect, with alcohol used as a primary coping strategy. Early individual therapy focuses on building insight and emotional awareness so the client can identify triggers and develop non-substance coping skills. Helping the client verbalize feelings supports therapeutic communication, reduces reliance on drinking to manage emotions, and strengthens engagement in treatment. Family role changes and social skills may be helpful later, and somatic preoccupation is not the central therapeutic target in initial substance-use counseling.

Question 14

The nurse is performing an assessment of a client with a history of polysubstance abuse. What is the most important information for the nurse to obtain?

Accepted Answer

Answer reason: Different substances have distinct onset and withdrawal windows (e.g., alcohol/benzodiazepine withdrawal can progress to seizures/delirium), so last-use timing directly guides urgency, safety precautions, and provider notifications. It also informs medication decisions (e.g., avoiding sedatives/opioids when recent use raises overdose risk) and need for detox protocols. Route, source, and location can matter, but they are secondary to immediate physiologic risk stratification driven by recency of use.

Question 15

What is the priority nursing intervention for a client recovering from cocaine addiction?

Accepted Answer

Answer reason: Recovery from stimulant use disorder requires insight into the presence and severity of dependence because denial and minimization commonly drive relapse. Helping the client accurately identify their addiction and its consequences supports motivation for change and engagement in treatment (e.g., relapse-prevention planning and support groups). Interventions like finding happiness, creative community activities, or workplace stress management can be useful later, but they are less effective if the client has not first accepted the substance use problem. Establishing this foundation allows subsequent coping-skill and lifestyle interventions to be targeted and realistic.

Question 16

Clients who are alcohol dependent usually require a two-phase treatment regimen. Which is an example of an effective two-phase treatment regimen?

Accepted Answer

Answer reason: Alcohol dependence treatment is commonly structured in two phases: acute stabilization of withdrawal followed by longer-term relapse prevention and recovery support. The first phase focuses on safely managing withdrawal symptoms and preventing complications such as seizures or delirium tremens, often with close monitoring and appropriate medications. The second phase addresses the chronic nature of addiction through counseling, behavioral therapies, support groups, and treatment of co-occurring conditions to reduce relapse risk. Options that include “purging,” “depression,” or “reformation” do not represent standard, evidence-based phases of alcohol use disorder care.

Question 17

The nurse is assessing the client who reports symptoms descriptive of hypoactive sexual desire disorder. Which biological factor identified in the client's history may predispose the client to hypoactive sexual desire disorder?

Accepted Answer

Answer reason: Long-term alcohol use is associated with impaired sexual arousal and desire through effects on testosterone/estrogen balance, mood, sleep, and neurologic responsiveness. In contrast, past sexual abuse and sexual identity conflicts are primarily psychosocial risk factors rather than biologic ones. Decreased prolactin would not typically reduce libido; elevated prolactin is the hormonal pattern more classically linked to reduced sexual desire and sexual dysfunction.

Question 18

The client is hospitalized after sustaining a head injury and a fractured wrist from a fall. The client admits to drinking alcohol in moderation several times per week. Which assessment finding should the nurse associate with early alcohol withdrawal?

Accepted Answer

Answer reason: Agitation is a classic early manifestation that can appear within hours and typically peaks in the first 24–48 hours. Somnolence is more consistent with intoxication, sedative exposure, or effects of head injury rather than withdrawal physiology. Delirium tremens is a late, severe complication (usually 48–96 hours) with confusion, hallucinations, and marked autonomic instability, not an early sign.

Question 19

The client taking disulfiram has a throbbing headache, diaphoresis, and sudden vomiting. Which possible conclusions by the nurse should be explored first?

Accepted Answer

Answer reason: Disulfiram intentionally causes an aversive reaction when alcohol is ingested by inhibiting aldehyde dehydrogenase, leading to acetaldehyde accumulation. The resulting disulfiram–alcohol reaction commonly produces headache, flushing/diaphoresis, nausea, and vomiting, and can escalate to hypotension and cardiovascular collapse, so this exposure must be assessed immediately. Exploring recent alcohol use is the highest-yield and most time-sensitive conclusion because it directly explains the symptom cluster and guides urgent monitoring/supportive care. Influenza is less likely to present with a sudden onset triad dominated by autonomic symptoms and emesis in this context. While hidden alcohol in OTC products or foods can contribute, the first priority is to assess direct alcohol intake as the most common and clinically dangerous trigger.

Question 20

The nurse is assessing the college student who presents with generalized fatigue, dry mouth, tachycardia, and an increased appetite. Which additional finding from the client's history and physical exam should alert the nurse to explore possible marijuana abuse?

Accepted Answer

Answer reason: Paranoid ideation is a classic additional mental-status finding that should prompt screening for marijuana use, particularly in young adults. Flashbacks are more characteristic of hallucinogens (e.g., LSD) rather than cannabis. “Conjunctival infection” is not the typical cannabis-associated eye finding; cannabis more often causes conjunctival injection (red eyes), not infection.

Question 21

The nurse educator is presenting a program on drug abuse to new nurses on the mental health unit. When explaining cocaine abuse, which street names for cocaine should the nurse include in the discussion?

Accepted Answer

Answer reason: These terms are widely used colloquially for cocaine, with “crack” referring to the smoked freebase form. The other options primarily correspond to different substances (e.g., cannabis and nicotine in one set, and amphetamines/methamphetamine in another). Teaching correct terminology improves screening, documentation, and patient education on a mental health unit.

Question 22

The client with a history of poly substance abuse is being medically detoxified in an acute care hospital. The client reported recently using alcohol, oxycodone, crack cocaine, and marijuana. In planning for detoxification, which substance for detoxification should be the nurse’s priority?

Accepted Answer

Answer reason: In acute detox planning, nursing priority focuses on preventing immediate physiologic deterioration and death, which is most strongly associated with alcohol withdrawal compared with the other listed substances. Opioid withdrawal from oxycodone is extremely uncomfortable but is typically not fatal when appropriately supported. Withdrawal from cocaine or marijuana generally does not produce a dangerous medical withdrawal syndrome requiring the same level of urgent prevention measures.

Question 23

The client is receiving clonidine to relieve selected symptoms of opioid withdrawal. Which assessment is most important for the nurse to complete before administering clonidine?

Accepted Answer

Answer reason: Before giving a dose, the nurse should assess vital signs—especially blood pressure—to prevent worsening hypotension, dizziness, syncope, or falls. While opioid withdrawal can cause mydriasis and GI upset, these findings do not determine whether clonidine can be safely administered. If blood pressure is low, the dose may need to be held and the prescriber notified per protocol.

Question 24

A client withdrawing from alcohol tells the nurse that he is worried about periodic hallucinations. What is the most appropriate intervention by the nurse?

Accepted Answer

Answer reason: Alcohol withdrawal can cause transient perceptual disturbances, and the nurse’s priority is therapeutic communication that supports safety, reality testing, and assessment of severity. Inviting the client to describe what is happening helps evaluate content, frequency, level of distress, and any risk for escalation to delirium tremens or self-harm. Confronting or arguing that the perception is not real can increase anxiety and defensiveness, worsening symptoms and impairing rapport. This approach also creates an opening to implement additional safety measures and notify the provider if symptoms intensify.

Question 25

The nurse is developing interventions to prevent a client who abused alcohol from relapsing. What is the most important intervention for the client?

Accepted Answer

Answer reason: Relapse prevention is built on identifying and avoiding high-risk triggers that are strongly conditioned to substance use. Environmental cues and social networks tied to past drinking commonly precipitate cravings and impaired judgment, making early recovery especially vulnerable. Reducing exposure to these triggers supports abstinence while new coping skills and sober supports are developed. In contrast, blanket avoidance of all OTC medications is unnecessary and misses the primary, evidence-based driver of relapse risk: cue-induced craving and access/opportunity.

Question 26

A client who abuses alcohol tells a nurse, “Alcohol helps me sleep.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason:  Therapeutic communication should acknowledge the client’s perception while gently introducing accurate education without arguing or shaming. Alcohol can initially cause sedation and shorten sleep onset, which validates what the client experiences in the moment. However, it disrupts sleep architecture (e.g., rebound wakefulness, fragmented sleep) and can worsen overall sleep quality, making absolute statements less helpful for engagement. Options that endorse alcohol as a sleep aid or imply a “safe” amount reinforce maladaptive coping and are not appropriate.

Question 27

A nurse is working with a client on recognizing the relationship between alcohol abuse and interpersonal problem. Which of the following is the priority intervention?

Accepted Answer

Answer reason: Insight-oriented work in substance use treatment begins with identifying denial, rationalization, projection, and minimization that block accurate self-appraisal. Focusing on these defenses directly supports the stated goal of recognizing how alcohol use contributes to interpersonal problems by making maladaptive thinking and blame-shifting explicit. This intervention also helps the client link triggers, consequences, and relationship patterns to use, which is necessary before selecting effective behavior changes. In contrast, building strengths and using peer role models can be helpful later, but they do not most directly address the immediate barrier to recognizing the alcohol–interpersonal relationship.

Question 28

What is the most important teaching information for the nurse to provide a client who abuses prescription drugs?

Accepted Answer

Answer reason: Core safety teaching in prescription drug misuse is to reinforce correct indication and adherence to the prescribed regimen to prevent escalation, diversion, and overdose. This guidance directly targets the behavior that defines prescription misuse—taking medications for nonprescribed purposes or in nonprescribed ways. Consulting a physician is helpful but less specific because it does not explicitly address using the medication strictly as ordered and can be misinterpreted as permission-seeking rather than adherence. Herbal products are not inherently safer and may worsen risk through interactions, and family influence is an assessment consideration rather than the most essential client teaching point.

Question 29

The nurse is facilitating a family meeting for a client who abuses alcohol. During the meeting, the nurse observes the communication and determines an unhealthy pattern of?

Accepted Answer

Answer reason: Families affected by alcohol use disorder commonly develop dysfunctional communication patterns such as denial, minimization, and avoidance to reduce anxiety and maintain homeostasis. Consistently steering away from disagreements prevents problem-solving, reinforces enabling behaviors, and blocks accountability and recovery-oriented change. Healthy family communication allows respectful discussion of concerns, boundaries, and consequences rather than suppressing them. While criticizing a behavior can be unhelpful if it becomes judgmental, the more characteristic unhealthy family-system pattern in substance misuse is avoiding conflict and difficult topics altogether.

Question 30

The nurse determines that teaching about cocaine has been effective when the client makes which statement?

Accepted Answer

Answer reason:  Addiction teaching is reflected when the client recognizes hallmark features such as tolerance and impaired control over use. The statement describes escalating amounts over time and loss of the ability to stop, which are classic indicators of substance use disorder. This demonstrates insight into the progressive nature of cocaine dependence rather than denial or minimization. In contrast, claiming non-addiction because use isn’t daily or limiting use to “holidays” reflects common rationalizations that ignore that dependence can occur with intermittent patterns as well. Identifying these dependence patterns suggests the education has improved understanding of the disorder.

Question 31

The parent expresses concern that her son, newly admitted to the mental health unit, may be using methamphetamine. Which nursing assessment findings are consistent with methamphetamine abuse?

Accepted Answer

Answer reason: This leads to decreased oral intake over time and noticeable weight loss, making this assessment finding strongly consistent with ongoing stimulant use. In contrast, hypotension/bradycardia and constricted pupils/fatigue are more consistent with depressant or opioid effects rather than stimulants. While bruises and scrapes may occur from risky behavior, they are nonspecific and do not point as directly to methamphetamine use as stimulant-associated anorexia and weight loss.

Question 32

The nurse is preparing to care for the newly hospitalized client diagnosed with Korsakoff’s psychosis from alcohol abuse. Which intervention should the nurse plan to implement?

Accepted Answer

Answer reason: Korsakoff’s psychosis is a neurocognitive syndrome caused by thiamine (vitamin B1) deficiency related to chronic alcohol use and poor nutrition. Replacing thiamine promptly helps prevent progression of Wernicke-Korsakoff injury and is a priority supportive intervention during hospitalization, especially before administering glucose-containing fluids that can worsen deficiency. Octreotide is used for conditions like variceal bleeding or acromegaly and does not address the underlying deficiency. Restraints and routine oxygen are not first-line unless there is an immediate safety or respiratory indication.

Question 33

A client experiencing alcohol withdrawal tells the nurse she is upset about going through detoxification. What is the most important goal for this client?

Accepted Answer

Answer reason: During acute alcohol withdrawal, the immediate priority is physiologic and environmental safety because patients are at risk for seizures, delirium tremens, severe autonomic instability, falls, and impulsive behavior. A goal focused on collaborating with nursing staff supports close monitoring, use of withdrawal protocols (e.g., CIWA-based care), timely medication administration, and safety precautions such as seizure and fall prevention. Longer-term recovery goals like committing to abstinence and building insight/strengths are important but are not the most urgent during detox. Hydration is supportive care, yet it does not address the highest-risk complications that can rapidly become life-threatening.

Question 34

During a family therapy session, an alcoholic client tells a family member, “You made it easy for me to use alcohol. You always made excuses for my behavior.” What should the nurse encourage the family to do?

Accepted Answer

Answer reason: Making excuses, covering up, or otherwise “making it easy” are classic enabling behaviors that maintain the addiction cycle. Encouraging the family to set boundaries and stop rescuing supports accountability and recovery-oriented treatment engagement. Managing the client’s self-care can unintentionally perpetuate dependence and decrease motivation for change. Evaluating the home environment may be useful, but it does not directly address the central problem of enabling described in the stem.

Question 35

A nurse is caring for a client undergoing treatment for acute alcohol dependence. The client tells the nurse, “I don’t have a problem. My wife made me come here.” Which defense mechanism does the nurse interpret the client’s statement as representing?

Accepted Answer

Answer reason: Rationalization provides a seemingly logical external explanation to reduce guilt or anxiety, reflected in blaming the spouse for the treatment (“my wife made me come here”). This pairing is common early in treatment when insight is limited and ambivalence is high. Suppression is a conscious decision to avoid thinking about an issue, which is not what the statement demonstrates.

Question 36

A client who abuses alcohol tells a nurse, “I’m sure I can become a social drinker.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason:  Therapeutic communication in substance use focuses on promoting insight and reality-based self-assessment without arguing or endorsing denial. This response uses an open-ended, nonjudgmental question that encourages the client to evaluate consequences of drinking, a core criterion of problematic use. It avoids reinforcing the false premise that controlled “social drinking” is a realistic goal for a person with alcohol dependence. In contrast, asking about numbers of drinks or timelines shifts the conversation to bargaining and can unintentionally validate continued alcohol use rather than exploring impact and readiness to change.

Question 37

A client recovering from alcohol abuse needs to develop effective coping skills to handle daily stressors. What is the most appropriate nursing intervention for this client?

Accepted Answer

Answer reason: Recovery from substance use requires replacing substance-based coping with adaptive, reality-based strategies for managing stress. Exploring and reinforcing prior successful coping helps the client identify strengths, build self-efficacy, and create a concrete coping plan that can be practiced and generalized to daily stressors. Avoidance of conflict tends to reinforce maladaptive patterns and limits skill development, increasing relapse risk when stress is unavoidable. Assessing verbal skills may inform communication approaches but does not directly teach coping. Simply encouraging acceptance without specific, practiced coping tools is too vague and may not equip the client to handle triggers effectively.

Question 38

A client tells a nurse, “I’m not going to have problems from smoking marijuana.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason:  A therapeutic, health-teaching response should provide accurate, nonjudgmental information that challenges denial without arguing. This option broadly and correctly reflects that cannabis use can be associated with clinically significant harms (e.g., impaired cognition/coordination with injury risk, respiratory irritation from smoking, anxiety/panic, and potential for cannabis use disorder). The other choices are either overly narrow, minimize risk, or reinforce the client’s belief, which can reduce motivation to consider change. A concise evidence-based statement is the safest and most appropriate first response.

Question 39

A client has stopped using phencyclidine (PCP). It is most important for the nurse to monitor the client’s behavior for which reason?

Accepted Answer

Answer reason: PCP is a dissociative drug that can produce severe perceptual disturbances, paranoia, and psychosis that may persist or re-emerge after stopping use. Monitoring for escalating bizarre, disorganized, or paranoid behavior is a priority because it can signal impending psychosis with high risk for violence, self-harm, and the need for rapid safety interventions. Behavioral changes are often the earliest observable indicator that the client’s mental status is deteriorating, allowing timely de-escalation and medical/psychiatric evaluation. While withdrawal-related irritability can occur, the more critical concern is progression to psychosis with impaired reality testing and unsafe behavior.

Question 40

The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone (ReVia). What is the best response by the nurse?

Accepted Answer

Answer reason: Because it displaces opioids from receptors, giving it during withdrawal can precipitate or worsen withdrawal rather than reverse symptoms. It is also not a sedative and does not affect memory of withdrawal experiences. Among the choices, the only option that aligns with a post-withdrawal medication strategy in opioid use disorder is the one contrasting it with methadone-based detox approaches, even though naltrexone’s role is maintenance/relapse prevention rather than replacing detoxification.

Question 41

A client discusses with the nurse how drug addiction has made life unmanageable. The nurse determines that information to assist the client with coping would include?

Accepted Answer

Answer reason: Effective coping in substance use disorder relies on relapse-prevention skills, especially identifying high-risk situations and cues that precipitate cravings and use. Teaching the client to recognize environmental triggers (people, places, paraphernalia, stressors) supports avoidance planning and development of alternative coping responses before urges escalate. This is immediately actionable information the client can use to reduce risk and regain a sense of control over “unmanageable” life circumstances. Peer examples may offer hope but are less individualized and do not directly build coping strategies. Deeper psychodynamic “family of origin work” is not the initial, most practical coping education for acute recovery needs.

Question 42

A polyaddicted client is hospitalized for withdrawal complications. What is the most important goal for this client?

Accepted Answer

Answer reason: During acute withdrawal, the priority nursing principle is physiologic safety because detox can cause life-threatening complications such as seizures, delirium, severe autonomic instability, dehydration, and aspiration risk. Hospitalization for withdrawal complications indicates immediate stabilization and prevention of harm are the most urgent goals before longer-term insight or behavior change can be realistically addressed. Goals like developing insight, maintaining abstinence, and learning coping skills are appropriate but occur after acute withdrawal is controlled and the client is medically stable. This prioritization aligns with ABCs and safety-first decision-making in substance withdrawal care.

Question 43

A client who abuses alcohol is admitted to an outpatient drug and alcohol treatment facility. The nurse determines that which of the following is the most objective way to determine if the client is still using alcohol?

Accepted Answer

Answer reason: A breath alcohol test provides a quantifiable estimate of recent alcohol use and reduces bias from the nurse’s perceptions or the client’s denial. In contrast, gait testing and odor on breath are subjective and can be influenced by neurologic conditions, medications, or mouthwash. Direct questioning is important therapeutically but is not the most objective method to verify ongoing use.

Question 44

A nurse is caring for a very pessimistic client undergoing treatment for cocaine abuse. The nurse anticipates the client may make which statement?

Accepted Answer

Answer reason: "I’ll never get better. This is useless." Early cocaine abstinence commonly produces a “crash” with dysphoria, anhedonia, and hopeless, pessimistic thinking. A statement reflecting helplessness and futility best matches this depressive cognitive pattern seen during withdrawal and early treatment. The fatigue option reflects a physiologic symptom but does not capture the defining pessimistic outlook the stem emphasizes. The “rush the treatment” option is more consistent with impatience or manic-like drive rather than withdrawal-related pessimism.

Question 45

The nurse overhears the spouse of an alcoholic client telling the client to “be quiet and don’t tell the physician anything about your drinking problem.” The nurse recognizes?

Accepted Answer

Answer reason: Codependency in substance use disorders commonly involves enabling, protecting the person from consequences, and maintaining secrecy to keep the dysfunctional system stable. Urging the client to hide alcohol use from the physician directly supports denial and blocks treatment, which is classic enabling behavior. It does not prove the spouse is the “authority” in the relationship; it only shows an attempt to control information flow. The client still has autonomy and the nurse has a professional responsibility to address barriers to care rather than ignore a safety-relevant disclosure.

Question 46

A client with a substance abuse problem is being discharged from the state treatment facility. The client's discharge plans should include which intervention?

Accepted Answer

Answer reason: Peer-support programs provide regular meetings, sponsorship, and a structured recovery framework that can continue long-term outside the facility. This intervention is realistic, widely available, and is a standard component of discharge planning for substance use disorders. Referral to Al-Anon is aimed at family members/significant others rather than the client, and routine urine testing alone does not provide the therapeutic support needed to maintain recovery.

Question 47

A client who experienced alcohol withdrawal syndrome is no longer having hallucinations or tremors and says he would like to enter a rehabilitation facility to stop drinking. What is the most appropriate intervention by the nurse?

Accepted Answer

Answer reason: After acute alcohol withdrawal symptoms resolve, the priority shifts to relapse prevention through structured, evidence-based treatment and continuity of care. A comprehensive treatment program (inpatient or outpatient) addresses detox follow-up, counseling/behavioral therapies, coping skills, and linkage to community supports, which best matches the client’s stated readiness for rehabilitation. Referring only to a peer-support group can be helpful but is not a substitute for a formal treatment plan when the client is requesting rehabilitation services. Focusing first on insurance or directing the client to family discussion does not address the immediate need to initiate sustained recovery resources and coordination.

Question 48

The nurse completed an admission interview and assessment of the client who is under the influence of cocaine. Which finding should the nurse attribute to the client being under the influence of cocaine?

Accepted Answer

Answer reason: During intoxication, the client may be unable to sustain focus long enough to participate reliably in an interview or follow questions. Decreased heart rate and blood pressure is more consistent with depressant effects rather than stimulant intoxication, making that option physiologically inconsistent. Hypersensitivity to questions and minimizing use can occur in many substance use disorders but are not as specific to acute stimulant intoxication as inattention and poor concentration.

Question 49

Family members of an alcoholic client ask the nurse to help them intervene. Which action is essential for a successful intervention?

Accepted Answer

Answer reason: Effective substance-use interventions rely on clear, specific, nonjudgmental feedback about observable behaviors and their direct impact to reduce denial and increase motivation for treatment. Having each family member share personal consequences provides consistent messaging and helps the client connect use with real-life losses, a key goal of a structured intervention. Telling the client they are “powerless” confuses the recovery concept (powerlessness over alcohol is a self-acknowledgment in AA, not something imposed by others) and is likely to provoke defensiveness. Financial contributions and acting as detox caregivers are not essential elements of an intervention and can reinforce enabling or blur professional boundaries in withdrawal management.

Question 50

A client who is withdrawing from alcohol is being given lorazepam (Ativan). The client’s family asks the nurse about the medication. What is the best response by the nurse?

Accepted Answer

Answer reason:  Benzodiazepines are first-line medications for alcohol withdrawal because they enhance GABA activity, reducing CNS hyperexcitability and lowering risk of seizures and delirium tremens. This directly addresses the family’s question by explaining the intended therapeutic effect in a clear, accurate way. Stating that short-term use leads to dependence is misleading in this context because the medication is typically used in a time-limited, monitored detox regimen where benefits outweigh that risk. The other choices are inaccurate: it does not “make him forget” symptoms, and it is not given to treat heart disease.

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