Question 1

A client is receiving chlordiazepoxide (Librium) as needed for signs and symptoms of alcohol withdrawal. The nurse assesses the client and determines the need for medication when the client displays?

Accepted Answer

Answer reason: Alcohol withdrawal produces autonomic hyperactivity from CNS rebound excitation, commonly presenting with tremor, elevated blood pressure, and tachycardia. PRN benzodiazepines are indicated to reduce withdrawal severity and prevent progression to seizures or delirium tremens. The other choices describe findings more consistent with excessive CNS depressant effect (e.g., hypotension, decreased reflexes, drowsiness, slurred speech) rather than untreated withdrawal. Sedation is an expected medication effect and would not be a trigger to give additional doses without concurrent withdrawal signs.

Question 2

A client addicted to alcohol tells a nurse, “Making friends used to be hard for me.” The nurse determines that client teaching about relationships has been successful when the client makes which statement?

Accepted Answer

Answer reason:  Healthy relationship skills in recovery include appropriate boundaries, personal responsibility, and respectful interpersonal behavior. This statement shows insight and the ability to set behavioral limits, which supports building and maintaining friendships without relapse-triggering conflict or codependency. The other options reflect maladaptive patterns—hostility/criticism, avoidance of intimacy, or fear-based withdrawal—that interfere with forming supportive relationships. Demonstrating boundary-setting is a concrete, teachable outcome indicating successful learning.

Question 3

The family of an adolescent who smokes marijuana asks a nurse if the use of marijuana leads to abuse of other drugs. What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: Nursing teaching should be factual, nonjudgmental, and reflect known risk relationships in substance use. Early cannabis use is associated with increased risk of later use of other substances, so acknowledging the potential progression supports prevention counseling without guaranteeing it will happen. Minimizing it as “a stage” or reassuring that “many people” don’t progress can undermine needed assessment and intervention. Saying the nurse can’t answer avoids the question rather than providing appropriate health education and guidance.

Question 4

The nurse is admitting a 35-year-old client to an inpatient substance abuse unit with a diagnosis of alcohol dependence. Which comment by the client would the nurse interpret as supporting this diagnosis?

Accepted Answer

Answer reason:  A core indicator of substance dependence is continued use despite recurrent significant problems and failure to meet role/safety obligations. Multiple recent DWI tickets reflect repeated hazardous use and legal consequences, showing impaired control and persistence of drinking despite clear negative outcomes. This pattern is much more consistent with dependence than isolated use with limits or preserved functioning. By contrast, limiting intake, reliably recalling events, or arranging a designated driver suggest more controlled use and risk-reduction behaviors rather than dependence.

Question 5

The client in group therapy states, “I’ve enjoyed using methylphenidate because of how it makes me feel.” The nurse should identify which additional statement with methylphenidate use?

Accepted Answer

Answer reason:  Methylphenidate is a CNS stimulant, so misuse commonly produces increased wakefulness, energy, decreased need for sleep, and euphoria. That statement reflects stimulant effects and a typical pattern of nontherapeutic use. In contrast, reporting improved sleep is inconsistent with expected pharmacologic effects, and weight gain is not typical (appetite suppression/weight loss is more common). Improved focus can occur therapeutically, but the combination with feeling unusually unconcerned/euphoric is less specific than clear stimulant-induced insomnia/activation.

Question 6

The nurse has just completed an assessment of a client recovering from alcohol addiction who has limited coping skills. During the assessment, the nurse also identified that the client is experiencing relationship problems. This assessment is supported by which finding?

Accepted Answer

Answer reason: Ineffective coping commonly manifests as difficulty generating options, evaluating consequences, and resolving interpersonal conflicts, which directly contributes to strained relationships. In recovery from alcohol use disorder, poor coping and impaired problem-solving often persist and can maintain maladaptive interaction patterns (e.g., avoidance, impulsive reactions, blaming). This finding best connects the limited coping-skills assessment to relationship problems because interpersonal functioning relies heavily on adaptive problem-solving. Panic attacks and poor attention to details are not specific indicators of relationship dysfunction, and inadequate rest relates more to stress management than to the core mechanism driving interpersonal conflict.

Question 7

A pregnant client is thinking about stopping cocaine use. The nurse determines that teaching about drug use and pregnancy has been effective when the client makes which statement?

Accepted Answer

Answer reason: " Substance exposure in utero can lead to neonatal abstinence/withdrawal symptoms and other complications, so recognizing fetal/neonatal risk reflects effective teaching and increased motivation to stop using. This statement shows the client understands a direct harm to the infant that can result from continued drug use and is expressing a protective goal consistent with behavior change. A common misconception is that the mother can simply manage the newborn’s withdrawal after birth, but withdrawal prevention requires maternal cessation and prenatal care rather than postpartum “getting through” it at home. Down syndrome is not a typical consequence specifically associated with cocaine use, so focusing on that suggests misunderstanding of the primary risks being taught.

Question 8

A client recovering from alcohol addiction asks the nurse how to talk to his children about the impact of addiction on them. What is the best response by the nurse?

Accepted Answer

Answer reason: Recovery communication with family is grounded in accountability, validation of others’ feelings, and repair of trust. This approach encourages an honest, age-appropriate conversation that recognizes the children’s experience and opens space for them to express emotions and ask questions. It avoids minimizing the impact or shifting the focus to the parent’s struggle, which can feel invalidating to children. It also supports healthier family dynamics by modeling responsibility and empathy—key elements of relapse-prevention and relationship repair.

Question 9

A client who abused alcohol for more than 20 years is diagnosed with cirrhosis of the liver. The nurse determines that teaching about the disease has been successful when the client makes which statement?

Accepted Answer

Answer reason:  Chronic alcohol use leads to physiologic dependence, so abruptly stopping can trigger severe withdrawal (e.g., seizures, delirium tremens) that can be life-threatening if not medically managed. This statement shows the client understands that cessation itself is not inherently fatal and implies awareness that safe stopping involves appropriate monitoring/treatment rather than continuing alcohol. The other options reflect misconceptions: blood pressure monitoring does not address progressive hepatic failure, and vitamins or supplements cannot reverse established cirrhotic scarring. Effective teaching emphasizes abstinence with supervised detox as needed and realistic expectations about irreversible liver damage.

Question 10

The nurse is trying to determine if a client who abuses heroin has any drug-related problems. What is the most appropriate question for the nurse to ask?

Accepted Answer

Answer reason:  A focused substance-use assessment uses nonjudgmental, behavior-based questions to identify functional consequences of use, including legal problems, which are a key indicator of a substance-related disorder. This question directly screens for drug-related impairment leading to adverse outcomes and helps quantify severity and risk. Asking about a probation officer is narrower and may miss clients with significant consequences but no formal supervision. Questions centered on the spouse or employee assistance program are indirect and can introduce assumptions or reduce accuracy compared with directly assessing consequences.

Question 11

A client with an alcohol addiction requests a prescription for disulfiram (Antabuse). To determine the client’s ability to take the drug appropriately, the nurse should assess which of the following?

Accepted Answer

Answer reason: Assessing intrinsic motivation is critical because the medication does not reduce craving; it relies on the client’s commitment to avoid alcohol and to take the drug as prescribed. Without motivation, nonadherence and intentional alcohol use are likely, which can precipitate a severe alcohol–disulfiram reaction and create safety risks. Family acceptance may support recovery but does not predict adherence as directly as the client’s readiness to remain abstinent. Dietary cautions exist (e.g., hidden alcohol in products) but the central determinant of appropriate use is commitment to sobriety.

Question 12

The nurse is teaching home health aides about monitoring for alcohol abuse in older adults. Which response by a home health aide indicates a need for further teaching?

Accepted Answer

Answer reason:  Retirement is a recognized risk period for increased substance use because of role loss, isolation, boredom, grief, and new unstructured time. Assuming alcohol use decreases can lead to under-assessment and missed early intervention in older adults. In contrast, alcohol misuse is common in this population and may present atypically (e.g., confusion, falls, malnutrition, self-neglect) rather than obvious intoxication. Teaching should emphasize that life transitions can increase vulnerability and that screening/monitoring should not be relaxed after retirement.

Question 13

The client states, “I don’t see any problem with smoking a little weed. It isn’t addictive.” Which response by the nurse is most accurate?

Accepted Answer

Answer reason:  Cannabis use can produce psychoactive effects and can lead to cannabis use disorder, so it is inaccurate to dismiss it as non-addictive. This response addresses the client’s minimization by linking cannabis to other substance classes associated with dependence potential and problematic use patterns. Option A is not the most accurate because legality and “natural” framing are not the key clinical point and vary by jurisdiction/medical indication. Option D is incorrect because withdrawal can occur (e.g., irritability, sleep disturbance, decreased appetite), which supports dependence potential and makes the client’s claim unsafe to reinforce.

Question 14

The nurse is teaching the client with a substance abuse disorder about 12—step self-help programs, such as AA. The nurse informs the client that the major principle associated with this 12-step program is what principle?

Accepted Answer

Answer reason: 12-step programs frame substance use disorder as a chronic disease characterized by loss of control, so recovery begins with acknowledging inability to control use. Step 1 specifically emphasizes admitting powerlessness and that life has become unmanageable, which supports engagement in ongoing support and relapse-prevention behaviors. The program does not teach that a person can return to “normal” controlled use, making that a common incorrect belief reflected in one distractor. It also avoids labeling addiction as a moral weakness “fixed” solely by belief, instead emphasizing acceptance, support, and continued recovery work.

Question 15

A client recovering from cocaine abuse is participating in group therapy. The nurse determines that the client has benefited from the therapy when the client makes which statement?

Accepted Answer

Answer reason:  Insight and motivation for change are key indicators that substance-use group therapy is helping, demonstrated by acknowledging consequences and weighing costs versus perceived benefits. This statement shows the client links cocaine’s reinforcing effects with its negative aftereffects and is beginning to reject the drug as “worth it,” reflecting improved insight and readiness to maintain abstinence. The other options reflect externalization/blaming, minimization, or lack of understanding rather than acceptance of personal responsibility and learning. Recognizing the harm-benefit imbalance is a clinically meaningful shift associated with reduced relapse risk and improved engagement in recovery.

Question 16

A family tells the nurse that they are concerned about a family member who stopped using amphetamines 3 months ago and is now acting paranoid. What is the best response by the nurse?

Accepted Answer

Answer reason: Stimulant (amphetamine) use can cause substance-induced psychotic symptoms such as paranoia that may persist beyond acute intoxication, especially after heavy or chronic use. This response provides accurate education that normalizes the concern while linking symptoms to a known effect of amphetamines over time. It also avoids blaming the family or making assumptions about ongoing use, which could undermine therapeutic communication. The other choices are either too nonspecific, focus on active abuse rather than post-use persistence, or introduce speculative psychosocial explanations instead of addressing the most likely substance-related cause.

Question 17

The 40-year-old client is recovering from an exacerbation of chronic pancreatitis. As the client prepares for discharge, the client makes several statements to the nurse. Which statement should be concerning because it could inhibit the client's ability to accomplish the developmental tasks of middle adulthood?

Accepted Answer

Answer reason:  Alcohol use is a common precipitating factor for chronic pancreatitis and increases risk of recurrence, complications, and functional decline. Planning to drink socially suggests a potential substance-use risk and poor adherence to a key lifestyle modification needed for long-term health maintenance. Recurrent exacerbations can impair the middle-adult developmental task of generativity through reduced work capacity, role functioning, and family/community engagement. In contrast, statements about community involvement, returning to work, and spousal support reflect adaptive coping and role maintenance rather than a barrier.

Question 18

The nurse is assessing the client with a history of paranoid schizophrenia and chronic alcohol abuse. The client has been taking olanzapinc for 2 weeks and has not consumed alcohol in the last 5 days. The client reports shaky hands and nightmares causing trouble sleeping, and has a concern that olanzapinc is the cause of the problems. Which is the nurse’s most therapeutic response?

Accepted Answer

Answer reason:  Alcohol withdrawal commonly begins within hours to a few days after cessation and can include tremor and sleep disturbance with vivid dreams or nightmares. The client’s timeline (5 days since last drink) and symptom cluster fit withdrawal more directly than olanzapine adverse effects, which more often involve sedation, weight gain, metabolic changes, or anticholinergic effects. A therapeutic response addresses the client’s concern with accurate, non-dismissive information and guides attention to the most clinically likely and potentially risky cause. In contrast, reassurance or telling the client to ignore symptoms minimizes potentially serious withdrawal and fails to support appropriate assessment and safety planning.

Question 19

The client is being treated for insomnia. The nurse thinks that the client is also experiencing a common comorbid condition. Which client behavior prompted the nurse’s conclusion?

Accepted Answer

Answer reason: Escalating amounts indicate tolerance and loss of control, which strongly supports dependence rather than a primary sleep disorder alone. Alcohol may initially sedate but worsens sleep architecture and rebound insomnia, perpetuating a maladaptive cycle. In contrast, compulsive rituals, paranoid delusions, or depressive hopelessness could coexist with insomnia, but they are not as specifically tied to a common insomnia comorbidity as alcohol misuse is.

Question 20

The client who is addicted to cocaine states, “I don’t really need treatment. Things just got a little out of hand, causing some problems. I can handle things on my own. I really need to get back to my business.” Which response by the nurse best assists the client to break through denial and get insight into the severity of the addiction?

Accepted Answer

Answer reason:  Therapeutic communication to reduce denial commonly uses reflection and presenting reality by gently pointing out discrepancies between the client’s statements and consequences. This response highlights the incongruence between “I can handle things” and the presence of significant problems, promoting insight without arguing or shaming. It supports motivational change by eliciting self-examination rather than shifting focus or colluding with minimization. In contrast, focusing on business (A) or simply inviting more thoughts without confronting inconsistency (B) is less likely to break denial, and asking about frequency (C) gathers data but does not directly address the defense mechanism.

Question 21

The nurse is discharging the client from an inpatient treatment program for cocaine abuse. Which statement by the client indicates an accurate understanding about the disease process of addiction?

Accepted Answer

Answer reason: “I didn’t realize that staying of drugs meant changing my thoughts and emotions. I thought I could just learn to stop using cocaine. NA will help me make these changes.” Addiction is a chronic relapsing disorder that requires ongoing recovery behaviors, not just stopping the substance. This statement shows insight that abstinence involves cognitive/emotional change and continued engagement in support systems to maintain recovery. It also reflects understanding that recovery is a process supported by community programs and coping-skill development rather than relying on willpower alone. By contrast, statements implying cravings will end permanently or that alcohol is “safe” despite a substance use disorder minimize relapse risk and misunderstanding of cross-addiction.

Question 22

The female client tells the nurse, “I usually have a few drinks after work, but I always limit it to three. I’m not risking becoming addicted, am I?” What is the nurse’s best response?

Accepted Answer

Answer reason: “Three drinks a day or seven drinks in a week is high-risk drinking for women. You seem concerned that you might have an alcohol dependency.” Nursing therapeutic communication should combine accurate health teaching with a nonjudgmental reflection of the client’s concern to support further assessment. This response provides objective risk information specific to women’s drinking thresholds and links it to the client’s stated worry, which invites discussion without labeling or arguing. It avoids minimizing alcohol risks or implying that lack of “social problems” means the pattern is safe, since harmful use can exist before obvious consequences. It also refrains from prematurely diagnosing dependence solely based on the client asking a question, instead using the concern as an opening for assessment and brief intervention.

Question 23

The client is being discharged from treatment for addiction to alprazolam and will be attending an addiction self-help group. Which statement indicates that the client has an accurate understanding of maintaining sobriety according to 12-step self-help principles?

Accepted Answer

Answer reason:  Maintaining sobriety in 12-step recovery emphasizes complete abstinence from mood-altering substances because cross-addiction and cue-triggered craving can rapidly destabilize early recovery. This statement reflects insight that any psychoactive drug exposure can reactivate addictive pathways and lead to relapse, especially after benzodiazepine dependence. Avoiding all anxiety-provoking situations is unrealistic and does not address developing coping skills and support use. Learning to “safely use” the drug of abuse or substituting alcohol represents continued substance use and undermines abstinence-based recovery.

Question 24

The nurse is developing the answer key to a post test that will be given to participants following a workshop about caffeine abuse among older adult clients. Which statement about caffeine abuse should be excluded from the answer key?

Accepted Answer

Answer reason: Caffeine is a CNS stimulant that most characteristically produces effects like increased alertness, diuresis, and sympathetic activation, which can include tachycardia, but it is not associated with a classic triad of hypoglycemia and decreased lipid levels as a defining feature of abuse. Caffeine withdrawal commonly presents with headache, fatigue, and dysphoric mood, making that statement consistent with established clinical patterns. Withdrawal symptoms typically start within about 12–24 hours after cessation, so that timing is also appropriate. The physiologic claims about glucose and lipid changes make this option the inaccurate statement to remove from the key.

Question 25

The mother of the 14-year-old tells the clinic nurse that she is concerned that her child may be “doing some sort of drugs.” The adolescent is confused and has difficulty answering questions clearly but admits to sniffing solvents in the family's garage. Which statement by the nurse is correct?

Accepted Answer

Answer reason:  Inhalant (solvent) abuse can produce acute CNS depression with confusion and can also cause life-threatening respiratory and cardiac complications, as well as longer-term neurotoxicity. This option correctly educates the parent about the significant medical risks associated with inhalants, supporting urgency for intervention and safety planning. The claim that there is little risk is unsafe because sudden death (e.g., arrhythmias) and hypoxia can occur even with short-term use. The other statements do not address the primary, evidence-based harm profile of inhalant exposure and could minimize the seriousness of the situation.

Question 26

The client undergoing a routine physical exam asks the nurse if taking the dietary supplement androstenedione, sometimes referred to as “andro,” would help to get in shape for football season. Which statement by the nurse is best?

Accepted Answer

Answer reason: “Benefits of androstenedione have not been proven. In fact, there appear to be more negative effects than benefits.” The key principle is client education about performance-enhancing supplements should emphasize lack of proven efficacy and potential harm. Androstenedione is an anabolic steroid precursor and has been associated with adverse endocrine and cardiovascular effects, so recommending it as a conditioning aid is unsafe. This option directly addresses both the limited evidence of benefit and the risk profile, supporting informed, harm-reduction counseling. Option A is true but incomplete because it focuses on regulation rather than clinical risk/benefit decision-making. Options C and D are unsafe because “natural” or “found in foods” does not make concentrated supplements effective or risk-free.

Question 27

The nurse is educating the client on the methadone prescribed for replacement therapy while in an outpatient treatment program for heroin addicts. The client asks how taking a pill is going to help the client stay substance-free. Which statement is the nurse’s best reply?

Accepted Answer

Answer reason:  Methadone is a long-acting opioid agonist used in opioid use disorder to prevent withdrawal, reduce cravings, and blunt the euphoric effect of short-acting opioids when taken as prescribed. This explanation correctly reflects replacement/maintenance therapy: stabilizing opioid receptors allows the client to function without cycles of intoxication and withdrawal. The “very sick if you take heroin” concept is characteristic of opioid antagonists (e.g., naltrexone) or disulfiram for alcohol, not methadone. Statements focusing on producing a “high” or sedation are inaccurate and can undermine adherence and safety teaching.

Question 28

Within a few hours of alcohol withdrawal, nurse John should assess the male client for the presence of?

Accepted Answer

Answer reason: Early expected findings include tremor and diaphoresis with vital-sign elevation, and patients can also develop low-grade fever as withdrawal escalates. These are key assessment targets because worsening autonomic instability can precede seizures and delirium tremens, requiring prompt escalation of monitoring and treatment. Options emphasizing yawning are more characteristic of opioid withdrawal, and severe confusion/paranoia is more typical of later delirium tremens rather than the earliest few hours.

Question 29

A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include?

Accepted Answer

Answer reason: g., lacrimation/rhinorrhea, nausea/vomiting, myalgias, yawning) rather than the classic opioid intoxication triad. This option includes lacrimation and vomiting, which are core withdrawal findings. Constipation and marked sedation are more consistent with opioid use/intoxication than withdrawal, making option B less fitting overall. Seizures/convulsions and hypothermia are not typical opioid withdrawal features and suggest other withdrawal syndromes or medical emergencies.

Question 30

A patient states that they cannot stop taking their medication because when they do, they feel symptoms such as nausea, vomiting, and pain. What is the name for what this patient is describing?

Accepted Answer

Answer reason: Nausea, vomiting, and diffuse pain are classic autonomic and somatic features seen with cessation of certain medications/substances (e.g., opioids). Dependence is the broader physiologic state of adaptation, whereas the acute symptom cluster that emerges when the drug is discontinued is withdrawal. Tolerance instead refers to needing higher doses to achieve the same effect, not experiencing illness on stopping.

Question 31

A client is transitioning to a less intensive level of outpatient treatment for addiction. The nurse concludes the client is most at risk for relapse after the client makes a statement reflecting which theme?

Accepted Answer

Answer reason: Concealing thoughts of use reflects impaired coping and a move away from relapse-prevention skills such as disclosure, urge-surfing, and contacting supports/sponsors. This also suggests shame and ambivalence, which commonly precede acting on cravings. By contrast, transient low mood or being hungry/tired can be common triggers but are safer when the client is open and actively using a plan to manage them.

Question 32

Which of the following interventions is most appropriate when working with the family of a client who is being treated for substance abuse?

Accepted Answer

Answer reason: Referring the family to resources such as Al-Anon/Nar-Anon, family therapy, and community counseling provides structured support, reinforces healthy boundaries, and addresses codependency and enabling patterns. Taking sides (either with the client or the family) undermines therapeutic neutrality and can escalate conflict, reducing engagement with treatment. A combined option that includes siding with the family is unsafe and inconsistent with therapeutic communication and collaborative care principles.

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