Substance Abuse and Abuse NCLEX Practice Quiz: 55 Questions| 2022 UPDATE Q&A RATED A+

Substance Abuse and Abuse NCLEX Practice Quiz: 55 Questions 1. 1. Question Nurse Rob has observed a co-worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co-worker? o A. Ignore the co worker's behavior, and frequently assess the clients assigned to the co-worker. o B. Make general statements about safety issues at the next staff meeting. o C. Report the coworker's behavior to the appropriate supervisor. o D. Warn the co-worker that this practice is unsafe. Incorrect Correct Answer: C. Report the coworker’s behavior to the appropriate supervisor. The nurse is obligated by ethical considerations of client safety, as well as by nurse practice acts in many states, to report substance abuse in health care workers. Most healthcare facilities have an employee assistance program to help workers with substance abuse problems. Alcohol and drug abuse by employees cause many expensive problems for business and industry ranging from lost productivity, injuries, and an increase in health insurance claims. The loss to companies in the United States due to alcohol and drug-related abuse by employees totals $100 billion a year, according to the National Clearinghouse for Alcohol and Drug Information (NCADI). • Option A: Ignoring the co-worker’s behavior would be a form of enabling behavior (codependency) on the staff nurse’s part. Misuse of alcohol and drugs among U.S. workers create costly medical, social, and other problems that affect both employees and employers. Substance abuse among employees can threaten public safety, impair job performance and threaten their own safety. • Option B: Making general statements about safety in a staff meeting avoids dealing with the problem. When the issue of workplace substance abuse is addressed by establishing comprehensive programs, it is a “win-win” situation for both employers and employees, according to the U.S. Department of Labor. Companies and employers, large and small, can adopt a workplace substance abuse policy that will reduce the loss of productivity and provide a safer work environment for all. • Option D: Warning the co-worker is inadequate; it does not ensure client safety or helps him receive necessary aid. The culture of the workplace can play a large role in whether drinking and drug use are accepted and encouraged or discouraged and inhibited. Part of this culture can depend on the gender mix of employees. Research shows that the job itself can contribute to higher rates of employee substance abuse. Work that is boring, stressful, or isolating can contribute to employees drinking. 2. 2. Question Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using? • A. Compensation • B. Denial • C. Suppression • D. Undoing Incorrect Correct Answer: B. Denial Individuals who have substance problems often use denial. Denial is probably one of the best-known defense mechanisms, used often to describe situations in which people seem unable to face reality or admit an obvious truth (e.g., “He’s in denial”). Addiction is one of the best-known examples of denial. People who are living with a substance use problem will often flat-out deny that their behavior is problematic. In other cases, they might admit that they do use drugs or alcohol but will claim that their substance use is not problematic. • Option A: Compensation is overachieving in one area to compensate for failures in another. This psychological strategy allows people to disguise inadequacies, frustrations, stresses, or urges by directing energy toward excelling or achieving in other areas. • Option C: Sometimes we do this consciously by forcing the unwanted information out of our awareness, which is known as suppression. In most cases, however, this removal of anxiety-provoking memories from our awareness is believed to occur unconsciously. • Option D: Undoing is trying to make up for what one feels are inappropriate thoughts, feelings, or behaviors (e.g., if you hurt someone’s feelings, you might offer to do something nice for them in order to assuage your anxiety or guilt). 3. 3. Question Nurse Tara is teaching a community group about substance abuse. She explains that a genetic component has been implicated in which of the following commonly abused substances? • A. Alcohol • B. Barbiturates • C. Heroin • D. Marijuana Incorrect Correct Answer: A. Alcohol Several chromosomes (1, 3, and 7) have been implicated in increased vulnerability to alcohol abuse. Statistics have shown that risk for alcohol abuse in first-degree relatives of alcohol abusers is as high as 40% to 60%. Most of the genetic research has been done related to alcohol. Some of the genes suspected include GABRG2 and GABRA2, COMT Val 158Met, DRD2 Taq1A, and KIAA0040. Personality disorders associated with the development of an alcohol use disorder include disinhibition and impulsivity-type disorders, as well as depressive and socialization-related disorders. • Option B: Barbiturate overdose can be intentional or unintentional. Decreased use of this controlled substance has led to a decrease in barbiturate-related fatalities. However, this medication should still be considered in cases of suspected overdose in patients with respiratory depression. A study in 2016 described two cases of intentional barbiturate overdose with medication purchased over the internet. These medications also can be obtained in laboratory settings as they are often used as buffers. • Option C: From 2002 through 2013, heroin overdoses went from 0.7 deaths per 100,000 to 2.7. In 2013, roughly 517,000 people reported heroin use in the past year, 1.5 times the amount in 2007. State and federal legislation are implementing diverse methods to curb this epidemic of heroin overdose deaths. The many infectious and economic effects of heroin dependence add to the risk of death. • Option D: Definitive data regarding genetic transmission is not available at this time for marijuana. Cannabis use varies based on demographics. Research shows college students, and young adults most commonly use cannabis to socially conform (42%), experiment (29%), and for enjoyment (24%). Twelve percent primarily use the agent to manage stress or relax consistent with other studies associating its use for depression, anxiety, social anxiety, and post-traumatic stress disorder. 4. 4. Question Nurse Julie recommends that the family of a client with substance-related disorder attend a support group, such as Al-Anon and Alateen. The purpose of these groups is to help family members understand the problem and to: • A. Change the problem behaviors of the abuser. • B. Learn how to assist the abuser in getting help. • C. Maintain focus on changing their own behaviors. • D. Prevent substance problems in vulnerable family members. Incorrect Correct Answer: C. Maintain focus on changing their own behaviors. Family support groups, such as Al-Anon and Alateen, emphasize the importance of changing one’s own behavior rather than trying to change the behavior of the individual with a substance abuse problem. The two disciplines, family therapy and substance abuse treatment, bring different perspectives to treatment implementation. In substance abuse treatment, for instance, the client is the identified patient (IP)—the person in the family with the presenting substance abuse problem. In family therapy, the goal of treatment is to meet the needs of all family members. Family therapy addresses the interdependent nature of family relationships and how these relationships serve the IP and other family members for good or ill. • Option A: The focus of family therapy treatment is to intervene in these complex relational patterns and to alter them in ways that bring about productive change for the entire family. Family therapy rests on the system’s perspective. As such, changes in one part of the system can and do produce changes in other parts of the system, and these changes can contribute to either problems or solutions. • Option B: Trying to change the abuser’s behavior or learning ways to find help for the abuser would be viewed as codependent behaviors, and thus would not be advocated by family support groups. It is important to understand the complex role that families can play in substance abuse treatment. They can be a source of help to the treatment process, but they also must manage the consequences of the IP’s addictive behavior. Individual family members are concerned about the IP’s substance abuse, but they also have their own goals and issues. Providing services to the whole family can improve treatment effectiveness. • Option D: Learning about substance abuse may help a vulnerable family member to avoid this problem; however, that is not the purpose of these groups. Meeting the challenge of working together will call for mutual understanding, flexibility, and adjustments among the substance abuse treatment provider, family therapist, and family. This shift will require a stronger focus on the systemic interactions of families. Many divergent practices must be reconciled if family therapy is to be used in substance abuse treatment. For example, the substance abuse counselor typically facilitates treatment goals with the client; thus the goals are individualized, focused mainly on the client. This reduces the opportunity to include the family’s perspective in goal setting, which could facilitate the healing process for the family as a whole. 5. 5. Question Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamine deficiency? • A. Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels. • B. CNS symptoms, such as ataxia and peripheral neuropathy. • C. Gastrointestinal symptoms, such as nausea and vomiting. • D. Respiratory symptoms, such as cough and sore throat. Incorrect Correct Answer: B. CNS symptoms, such as ataxia and peripheral neuropathy Wernicke’s encephalopathy is a CNS disorder caused by acute thiamine deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium. Deficiency of thiamine can affect the cardiovascular, nervous, and immune system, as is commonly seen in wet beriberi, dry beriberi, or as Wernicke-Korsakoff syndrome. Wet and dry beriberi often have overlapping features, and in either condition, paresthesias may be a presenting feature. • Option A: Cardiovascular symptoms are usually associated with alcohol abuse. The patient may have hypertension (HTN) or insomnia initially. In later stages, the patient may complain of nausea/vomiting, hematemesis, abdominal distension, epigastric pain, weight loss, jaundice, or other symptoms or signs suggestive of liver dysfunction. They may be asymptomatic early on. • Option C: Gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamine deficiency. On exam, they may exhibit signs of cerebellar dysfunction, such as ataxia or difficulty with fine motor skills. They may exhibit slurred speech, tachycardia, memory impairment, nystagmus, disinhibited behavior, or hypotension. They may present with tremors, confusion/mental status changes, asterixis, ruddy palms, jaundice, ascites, or other signs of advanced liver disease. There may also be spider angiomata, hepatomegaly/splenomegaly (early; liver becomes cirrhotic and shrunken in advanced disease). • Option D: Respiratory problems are not usually directly related to alcohol. Marijuana smoke can also cause respiratory problems, including chronic bronchitis. Smoking crack cocaine can cause lung damage and severe respiratory problems. The use of some drugs, such as opioids, may cause breathing to slow, block air from entering the lungs, or make asthma symptoms worse. 6. 6. Question Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in: • A. Abdominal cramps and diarrhea • B. Drowsiness and decreased respiration • C. Flushing, vomiting, and dizziness • D. Increased pulse and blood pressure Incorrect Correct Answer: C. Flushing, vomiting, and dizziness Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites. Disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat chronic alcohol dependence. In its pure state, disulfiram is a white to off-white, odorless, almost tasteless powder, which is soluble in water and alcohol. Disulfiram, an alcohol-aversive or alcohol-sensitizing agent, causes an acutely toxic physical reaction when mixed with alcohol. • Option A: The disulfiram-alcohol reaction usually begins about 10 to 30 minutes after alcohol is ingested. Its adverse effects range from moderate to severe. Intensity varies with individual patient characteristics. The reaction is generally proportional to the amounts of disulfiram and alcohol ingested. Mild effects may occur at blood alcohol concentrations of 5 to 10 mg/100 mL. At 50 mg/100 mL, effects usually are fully developed. When the concentration reaches 125 to 150 mg/100 mL, unconsciousness may occur. • Option B: About 80 to 95 percent of ingested disulfiram is absorbed from the gastrointestinal tract and rapidly distributed to tissues and organs. It is then metabolized to various mixed disulfides. The unabsorbed fraction is excreted. Disulfiram is irreversibly bound to ALDH. It can take up to 2 weeks for the body to synthesize sufficient unbound enzymes to metabolize alcohol adequately. This is why alcohol ingestion may produce unpleasant symptoms for up to 2 weeks after a patient has taken the last dose of disulfiram. • Option D: The consensus panel concludes that disulfiram is most effective for patients who have undergone detoxification or are in the initiation stage of abstinence, especially when they are committed to abstinence and receive adequate, ongoing supervision. Disulfiram may not reduce the urge to drink alcohol. However, it may assist in motivating the patient not to drink. As with other medications, general efficacy also increases when disulfiram is administered in conjunction with intensive behavioral interventions. 7. 7. Question 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 Incorrect Correct Answer: C. Restore depleted dopamine levels 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. • Option A: Bromocriptine is a dopamine receptor agonist that has selective agonist activity on D2 dopamine receptors while simultaneously acting as a partial antagonist for D1 dopamine receptors. Dopamine agonism has variable effects depending on the target tissue. • Option B: The patient acutely intoxicated on amphetamines will require chemical and physical restraints to prevent self-harm or harm to others, as these patients can be hostile with severe paranoia. Some life-threatening signs and symptoms need to be addressed on an emergent basis such as trauma, compromised airway, seizures, and any cardiac dysrhythmias. • Option D: Amphetamine abuse is widespread and associated with a significant impact on cardiovascular and neurological systems in overdose. In many parts of the world, amphetamines have been an abused class of drugs since the 1930s. Methamphetamine (METH) and its derivative, 3,4-methylenedioxymethamphetamine (MDMA), are extensively abused drugs, and the acute effects of these drugs include increased alertness, hyperthermia, decreased appetite, and euphoria. 8. 8. Question Which medication is commonly used in treatment programs for heroin abusers to produce a non-euphoric state and to replace heroin use? • A. Diazepam • B. Carbamazepine • C. Clonidine • D. Methadone Incorrect Correct Answer: D. Methadone Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a non euphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin. Methadone is an alternative in treating patients with opioid-tolerance as they may not respond to traditional analgesic regimens. In such patients, methadone dosages are adjusted, or combined with other opioids as adjuvant treatments to enhance response to analgesic interventions. • Option A: Diazepam is an anxiolytic benzodiazepine, first patented and marketed in the United States in 1963. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders. In the setting of acute alcohol withdrawal, diazepam is useful for symptomatic relief of agitation, tremor, alcoholic hallucinosis, and acute delirium tremens. • Option B: Carbamazepine may be used for withdrawal from alcohol, barbiturates, and benzodiazepines. In patients with moderate to severe alcohol withdrawal syndrome, carbamazepine has shown to have clinical efficacy in treatment. Researchers proposed that carbamazepine keeps sodium channels in inactivated states, leading to fewer channels to open, and thus inhibits the generation of action potentials. • Option C: Clonidine can be used in acute withdrawal from heroin to avoid norepinephrine rebound when opiates are stopped. Clonidine has multiple off-label uses such as the management of withdrawal symptoms from opioids, benzodiazepines, and alcohol, and for treatment of anxiety, insomnia, and post-traumatic stress disorder (PTSD). Clonidine hydrochloride is an imidazoline derivative that acts centrally on alpha-2 adrenergic as an agonist. The chemical name for clonidine is 2-((2,6-dichlorophenyl) amino)-2-imidazoline hydrochloride. 9. 9. Question Nurse Christine is teaching an adolescent health class about the dangers of inhalant abuse; the nurse warns about the possibility of: • A. Contracting an infectious disease, such as hepatitis or AIDS. • B. Recurrent flashback events. • C. Psychological dependence after initial use. • D. Sudden death from cardiac or respiratory depression Incorrect Correct Answer: D. Sudden death from cardiac or respiratory depression. Inhalants are CNS depressants; if taken in an excess amount, they can cause cardiac and respiratory depressions. It is impossible to control the inhalant dosage; therefore, death can occur. Prognosis depends upon follow up and motivational and cognitive behavior therapy. Support like Alcoholics-Anonymous groups play an important role in prognosis. Substance use leads to a number of problems among youth, including accidents, death, health effects, crime, unplanned pregnancy, and lower achievement. • Option A: Substance use and/or substance use disorders (SUDs) are associated with many negative consequences among youth, including accidents, death, health effects, crime, unplanned pregnancy, and lower achievement. Substance use contributes to accidents, death, and a variety of hazardous behaviors. Sexual behaviors are increased during adolescent substance use. • Option B: Posttraumatic stress disorder (PTSD) is a syndrome that results from exposure to real or threatened death, serious injury, or sexual assault. The symptoms of PTSD include persistently re-experiencing the traumatic event, intrusive thoughts, nightmares, flashbacks, dissociation(detachment from oneself or reality), and intense negative emotional (sadness, guilt) and physiological reaction on being exposed to the traumatic reminder. • Option C: As with most behavioral and psychiatric disorders, the interplay between genetic risk, temperamental traits, and the environment may predispose to early use of substances of abuse. Once exposed to substances, brain reward systems reinforce substance use, resulting in repeated use and lower ability to control substance use. 10. 10. Question The newly hired nurse at Nurseslabs Medical Center is assessing a client who abuses barbiturates and benzodiazepine. The nurse would observe for evidence of which withdrawal symptoms? • A. Respiratory depression, stupor, and bradycardia • B. Anxiety, tremors, and tachycardia • C. Muscle aches, cramps, and lacrimation • D. Paranoia, depression, and agitation Incorrect Correct Answer: B. Anxiety, tremors, and tachycardia Barbiturates and benzodiazepine are CNS depressants; therefore, withdrawal symptoms are related to CNS stimulation caused by the rebounding of neurotransmitters (norepinephrine). Symptoms include increased anxiety, tremors, and vital sign changes (such as tachycardia and hypertension). Chronic abusers can develop severe withdrawal symptoms within 8 to 15 hours of cessation. Symptoms include restlessness, tremors, hyperthermia, sweating, insomnia, anxiety, seizures, circulatory failure, and potentially death. • Option A: Respiratory depression, stupor, and bradycardia are typically associated with an overdose—not withdrawal—of barbiturates or benzodiazepine. Symptoms of barbiturate toxicity vary from case to case, but commonly include difficulty thinking, decreased level of consciousness, bradycardia or rapid and weak pulse, poor coordination, vertigo, nausea, muscle weakness, thirst, oliguria, decreased temperature, and dilated or contracted pupils. Fatal cases are marked by coma, hypotension (low blood pressure), and respiratory depression (decreased efforts to breathe) evidenced by cyanosis and hypotension • Option C: Muscle aches, cramps, and lacrimation are most commonly associated with withdrawal from opiates. According to Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid withdrawal include lacrimation or rhinorrhea, piloerection “goose flesh,” myalgia, diarrhea, nausea/vomiting, pupillary dilation and photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning. • Option D: Paranoia, depression, and agitation are usually associated with withdrawal from CNS stimulants, such as amphetamines or cocaine. Central nervous system (CNS) stimulants like cocaine and amphetamine can also produce withdrawal symptoms. Like opioids, the withdrawal symptoms are mild and not life-threatening. Often the individual will develop marked depression, excessive sleep, hunger, dysphoria, and severe psychomotor retardation but all vital functions are well preserved. Recovery is usually slow, and depression can last for several weeks. 11. 11. Question The community nurse practicing primary prevention of alcohol abuse would target which groups for educational efforts? • A. Adolescents in their late teens and young adults in their early twenties. • B. Elderly men who live in retirement communities. • C. Women working in careers outside the home. • D. Women working in the home. Incorrect Correct Answer: A. Adolescents in their late teens and young adults in their early twenties High-risk groups for alcohol abuse include individuals between ages 18 and 25 and the unemployed. According to the 2015 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Administration, an estimated 20.8 million Americans age 12 and older had a substance use disorder, of which 15.7 million were alcohol use disorders. Of the people with alcohol use disorder and illicit drug disorder, 623,000 of these were adolescents ages 12 to 17 (2.5% of all adolescents). • Option B: There is no evidence that elderly men in retirement communities have increased rates of alcohol abuse. Almost four million (3.8 million) individuals ages 18-25 (10.9% of young adults) and 11.3 million individuals 26 years or older (5.4%) had both an alcohol use disorder and illicit drug disorder. However, this number has been steadily declining since 2002. Almost half of the people with any substance abuse problem, including alcohol, also had a co-existing mental illness. • Option C: Rates of the disorder are greater among adult men (12.4%) than among adult women (4.9%). Alcohol use disorder is a common disorder in the United States. The 12-month prevalence of alcohol use disorder is estimated to be 4.6% among 12 to 17-year-olds and 8.5% among adults aged 18 years and older in the United States. • Option D: Men have 2 to 3 times increased risk than women of abusing alcohol. Among adults, the 12-month prevalence of alcohol use disorder is clearly greater among Native Americans and Alaska Natives (12.1%) than among whites (8.9%), Hispanics (7.9%), African Americans (6.9%), and Asian Americans and Pacific Islanders (4.5%). 12. 12. Question Johnette is reviewing her lessons in Pharmacology. She is aware that the general classification of drugs belonging to the opioid category is analgesic and: • A. Tranquilizing • B. Hallucinogenic • C. Stimulant • D. Depressant Incorrect Correct Answer: D. Depressant Opiates are both analgesics and CNS depressants because they decrease the effect of neurotransmitters that are excitatory or stimulating. Opioids act both presynaptically and postsynaptically to produce an analgesic effect. Presynaptically, opioids block calcium channels on nociceptive afferent nerves to inhibit the release of neurotransmitters such as substance P and glutamate, which contribute to nociception. Postsynaptically, opioids open potassium channels, which hyperpolarize cell membranes, increasing the required action potential to generate nociceptive transmission. The mu, kappa, and delta-opioid receptors mediate analgesia spinal and supraspinal. • Option A: Although an opiate can provide a tranquilizing effect; the general category would be that of a depressant. Tranquilizer, also spelled Tranquillizer, a drug that is used to reduce anxiety, fear, tension, agitation, and related states of mental disturbance. Tranquilizers fall into two main classes, major and minor. Major tranquilizers, which are also known as antipsychotic agents, or neuroleptics, are so called because they are used to treat major states of mental disturbance in schizophrenics and other psychotic patients. By contrast, minor tranquilizers, which are also known as antianxiety agents, or anxiolytics, are used to treat milder states of anxiety and tension in healthy individuals or people with less serious mental disorders. • Option B: Hallucinogens are a diverse group of drugs that alter a person’s awareness of their surroundings as well as their own thoughts and feelings. They are commonly split into two categories: classic hallucinogens (such as LSD) and dissociative drugs (such as PCP). Both types of hallucinogens can cause hallucinations or sensations and images that seem real though they are not. Additionally, dissociative drugs can cause users to feel out of control or disconnected from their body and environment. • Option C: Stimulant is a category that does not apply to opiates. Stimulants are a class of drugs that speed up the messages between the brain and the body. They can make a person feel more awake, alert, confident or energetic. Large doses of stimulants can cause over-stimulation, causing anxiety, panic, seizures, headaches, stomach cramps, aggression, and paranoia. Long-term use of strong stimulants can also cause a number of adverse effects. Stimulants include caffeine, nicotine, amphetamines, and cocaine. 13. 13. Question When a client abuses a CNS depressant, withdrawal symptoms will be caused by which of the following? • A. Acetylcholine excess • B. Dopamine depletion • C. Serotonin inhibition • D. Norepinephrine rebound Incorrect Correct Answer: D. Norepinephrine rebound CNS depressants, when abused, cause depletion of stimulating neurotransmitters. When the CNS depressant is stopped, the result is a rebound of excitatory or stimulating neurotransmitters, such as norepinephrine. Central Nervous System (CNS) depressants are medicines that include sedatives, tranquilizers, and hypnotics. These drugs can slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders. • Option A: Most CNS depressants act on the brain by increasing activity of gamma-aminobutyric acid (GABA), a chemical that inhibits brain activity. This action causes the drowsy and calming effects that make the medicine effective for anxiety and sleep disorders. People who start taking CNS depressants usually feel sleepy and uncoordinated for the first few days until the body adjusts to these side effects. • Option B: If a person takes CNS depressants long term, he or she might need larger doses to achieve therapeutic effects. Continued use can also lead to dependence and withdrawal when use is abruptly reduced or stopped. Suddenly stopping can also lead to harmful consequences like seizures. • Option C: Acetylcholine, dopamine, and serotonin are not significant factors in the symptoms of withdrawal from a CNS depressant. When people overdose on a CNS depressant, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage. 14. 14. Question Kendall, the sister of a client with a substance-related disorder, tells the nurse she calls out sick for her sister Kylie occasionally when the latter has too much to drink and cannot work. This behavior can be described as: • A. Caretaking • B. Codependent • C. Helpful • D. Supportive Incorrect Correct Answer: B. Codependent Enabling behaviors that inadvertently promote continued use of a substance by the person abusing substances is known as codependency. Codependency is a type of dysfunctional relationship that involves one person’s self-esteem and emotional needs being dependent on the other person. The codependent person may also enable the other person’s unhealthy behaviors. • Option A: The sister’s behavior is not an example of caretaking or support. She is taking responsibility for the client’s behavior and allowing her to avoid the consequences of his abuse problem. People in a relationship with those who have alcohol use disorder can develop codependency, which is an unhealthy focus on the other person’s needs over their own. Nonetheless, codependency can happen in relationships without alcoholism, generally in a different type of caretaker situation, such as a relationship involving a physical or mental illness. Treatment can help people with codependency improve their own self-esteem and learn to have healthier relationships. • Option C: Alcohol abuse can isolate a person from the outside world. But at home, in the family, there is no isolation or separation; everyone who lives with an alcoholic is affected by their illness and the frightening and unpredictable behavior it causes. • Option D: The behavior is unhelpful and unsupportive. Oftentimes, when family dynamics are corrupted by alcohol the two dominant emotions in the household are denial and shame, which are clearly interrelated. The whole family may cooperate in hiding the truth about the alcohol abuse from others, even as they refuse to accept the full truth among themselves. Extended family members may or may not go along with this ruse, but if they do try to confront the person with the alcohol use disorder they may be rebuffed—not just by the alcoholic, but by spouses, children, or others living in the home. 15. 15. Question During an initial assessment of a client admitted to a substance abuse unit for detoxification and treatment, the nurse asks questions to determine patterns of use of substances. Which of the following questions are most appropriate at this time? Select all that apply. • A. How long have you used substances? • B. How often do you use substances? • C. How do you get substances into your body? • D. Do you feel bad or guilty about your use of substances? • E. How much of each substance do you use? • F. Have you ever felt you should cut down substance use? • G. What substances do you use? Incorrect Correct Answer: A, B, C, E, G These questions will elicit information about the client’s pattern of use of substances. • Options D and F: These are questions related to CAGE, a tool for screening suspected substance abusers. • Option A: Across ethnic and cultural population groups, major risk factors for substance initiation and dependence among women include chaotic, argumentative, blame-oriented, and violent households. As a general tenet, women who grew up in families where they take on adult responsibilities as a child, including household duties, parenting of young children, and emotional support of parents, are more likely to initiate drug and alcohol use. • Option B: Premorbid personality risk factors that lay the foundation for substance abuse (besides depressive features) include obsessiveness and anxiety, difficulty in regulating affect and behavior (such as temper tantrums and frequent tearfulness), and low self-worth and ego integration (Brook et al. 1998). According to Page (1993), a negative self-perception of physical attractiveness is associated with increased illicit drug use. • Option C: Even though women are less likely to inject drugs than men, research suggests that women accelerate to injecting at a faster rate than men (Bryant and Treloar 2007). When women inject drugs for the first time, they are more likely than men who are first-time injectors to be introduced to this form of administration by a sexual partner (Frajzyngier et al. 2007). Women are more likely to be involved with a sexual partner who also injects. • Option D: The CAGE questionnaire is a series of four questions that doctors can use to check for signs of possible alcohol dependency. The questions are designed to be less obtrusive than directly asking someone if they have a problem with alcohol. • Option E: Drinking low to moderate levels of alcohol in early adulthood is a predictor of later heavy drinking and alcohol-related substance use disorders among women (Andersen et al. 2003; Morgen et al. 2008). In addition to amount of alcohol intake, frequency of use appears positively associated with risk of alcohol dependence, particularly for women (Flensborg-Madsen et al. 2007). Females who begin smoking at a young age are more likely to initiate alcohol and drug use than females who do not smoke. • Option F: The CAGE questionnaire, along with related tests, try to remove any potential for personal judgement by asking very simple, direct questions that don’t accuse someone of any wrongdoing. For example, the second question asks how other people perceive their drinking, rather than asking how someone is drinking directly affects those around them. • Option G: SAMHSA’s National Survey on Drug Use and Health (NSDUH) interviews yearly more than 67,000 persons ages 12 or older to assess their use of alcohol and illicit drugs and their symptoms of substance abuse or dependence during the past year (SAMHSA 2007). Results of NSDUH for 2006 indicate that 45.2 percent of females ages 12 or older used alcohol during 2006, and 6.2 percent reported current illicit drug use. 16. 16. Question The nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client? • A. Ping pong • B. Writing • C. Chess • D. Basketball Incorrect Correct Answer: B. Writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing, walks with a staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension. Provide structured solitary activities with the assistance of a nurse or aide. Structure provides focus and security. • Option A: Ping-pong is a competitive sport. Provide frequent rest periods. Maintaining a low level of stimuli in the client’s environment (e.g., loud noises, bright light, low-temperature ventilation) helps minimize escalation of anxiety. Provide frequent high-calorie fluids (e.g., fruit shake, milk). Prevents the risk of serious dehydration. • Option C: Solitary activities requiring short attention spans with mild physical exertion are best initially (e.g., writing, taking photos, painting, or walks with staff). Solitary activities minimize stimuli; mild physical activities release tension constructively. When possible, provide an environment with minimum stimuli (e.g., quiet, soft music, dim lighting). Reduction in stimuli lessens distractibility. • Option D: Competitive games can stimulate aggression and increase psychomotor activity. When less manic, the client might join one or two other clients in quiet, non-stimulating activities (e.g., drawing, board games, cards). As mania subsides, involvement in activities that provide a focus and social contact becomes more appropriate. Competitive games can stimulate aggression and can increase psychomotor activity. 17. 17. Question A client is admitted to the hospital with a diagnosis of major depression, severe, single episode. The nurse assesses the client and identifies a nursing diagnosis of imbalanced nutrition related to poor nutritional intake. The most appropriate nursing intervention related to this diagnosis is: • A. Explain to the client the importance of a good nutritional intake. • B. Weight the client 3 times per week before breakfast. • C. Report the nutritional concern to the psychiatrist and obtain a nutritional consultation as soon as possible. • D. Consult with the nutritionist, offer the client several small meals per day, and schedule brief nursing interactions with the client during these times. Incorrect Correct Answer: D. Consult with the nutritionist, offer the client several small meals per day and schedule brief nursing interactions with the client during these times. Change in appetite is one of the major symptoms of depression. Weight the client weekly and observe the eating patterns of the client. Give the information needed for revising the intervention. Encourage eating with others. This increases socialization, decreases focus on the food. • Option A: Encourage small, high-calorie, and high-protein snacks and fluids frequently throughout the day and evening if weight loss is noted. This minimizes weight loss, constipation, and dehydration. Serve foods or drinks the client likes. Clients are more likely to eat foods they like. • Option B: Help the client identify negative thinking/thoughts. Teach the client to reframe and/or refute negative thoughts. Negative ruminations add to feelings of hopelessness and are part of a depressed person’s faulty thought processes. Intervening in this process helps in a healthier and more useful outlook in life. • Option C: Reporting to the psychiatrist and nutritionist is to some degree correct but lacks the method as to how one would increase food intake. Allow more time than usual for the client to finish usual activities of daily living (ADL) (e.g., eating, dressing). Usual tasks might take long periods of time; demands that the client hurry only increases anxiety and slow down the ability to think clearly. 18. 18. Question In planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plans is best? • A. Provide an activity that is quiet and solitary to avoid increased fatigue, such as working on a puzzle or reading a book. • B. Plan nothing until the client asks to participate in milieu. • C. Offer the client a menu of daily activities and insist the client participate in all of them • D. Provide a structured daily program of activities and encourage the client to participate. Incorrect Correct Answer: D. Provide a structured daily program of activities and encourage the client to participate. A depressed person experiences a depressed mood and is often withdrawn. The person also experiences difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness, and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment. Involve the client in gross motor activities that call for very little concentration (e.g., walking). Such activities will aid in relieving tensions and might help in elevating the mood. • Option A: Initially, provide activities that require minimal concentration (e.g., drawing, playing simple board games). Depressed people lack concentration and memory. Activities that have no “right or wrong” or “winner or loser” minimizes opportunities for the client to put himself/herself down. When the client is in the most depressed state, Involve the client in a one-to-one activity. Maximizes the potential for interactions while minimizing anxiety levels. • Option B: Eventually involve the client in group activities (e.g., group discussions, art therapy, dance therapy). Socialization minimizes feelings of isolation. Genuine regard for others can increase feelings of self-worth. Eventually maximize the client’s contacts with others (first one other, then two others, etc.). Contact with others distracts the client from self-preoccupation. • Option C: This is a forceful and absolute approach. Allow the patient to engage in simple recreational activities, advancing to more complex activities in a group environment. The patient may feel overwhelmed at the start when participating in a group setting. Encourage the client to participate in group therapy where the members share the same situations/feelings that they have. 19. 19. Question The depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as “I’m such a failure… I can’t do anything right!” The best nursing response would be: • A. To tell the client this is not true; that we all have a purpose in life. • B. To remain with the client and sit in silence; this will encourage the client to verbalize feelings. • C. To reassure the client that you know how the client is feeling and that things will get better. • D. To identify recent behaviors or accomplishments that demonstrate skill ability. Incorrect Correct Answer: D. To identify recent behaviors or accomplishments that demonstrate skill ability. Feelings of low self-esteem and worthlessness are common symptoms of the depressed client. An effective plan of care to enhance the client’s personal self-esteem is to provide experiences for the client that are challenging but will not be met with failure. Reminders of the client’s past accomplishments or personal successes are ways to interrupt the client’s negative self-talk and distort the cognitive view of self. Silence may be interpreted as agreement. • Option A: Assess the self-esteem level of the patient. Signs of low self-esteem include withdrawal from social relationships, feeling of inadequacy, neglect of personal hygiene and dress, and rejecting self which all may indicate a negative thought pattern. Allow the patient to perform personal care activities. Paying attention to grooming serves as a first step towards achieving positive self-image. • Option B: Give positive feedback after a task is achieved. Positive reinforcement has a big part in building self-esteem. Teach visualization techniques that can help the client replace negative self-images with more positive images and thoughts to promote a healthier and more realistic self-image by helping the client choose more positive thoughts and actions. • Option C: This gives advice and devalues the client’s feelings. Encourage the client to participate in a group therapy where the members share the same situations/feelings that they have to minimize the feelings of isolation and provide an atmosphere where positive feedback and a more realistic appraisal of self are available. Involve the client in activities that he or she wants to improve by using problem-solving skills. Assess and evaluate the need for more teaching in this area. 20. 20. Question A client with a diagnosis of major depression, recurrent with psychotic features is admitted to the mental health unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals specifically with the client’s: • A. Disturbed thought processes • B. Imbalanced nutrition • C. Self-care deficit • D. Deficient knowledge Incorrect Correct Answer: A. Disturbed thought processes Major depression, recurrent, with psychotic features alerts the nurse that in addition to the criteria that designate the diagnosis of major depression, one also must deal with the client’s psychosis. Psychosis is defined as a state in which a person’s mental capacity to recognize reality and to communicate and relate to others is impaired, thus interfering with the person’s capacity to deal with the demands of life. Altered thought processes generally indicate a state of increased anxiety in which hallucinations and delusions prevail. Although all of the nursing diagnoses may be appropriate because the client is experiencing psychosis, option A is correct. • Option B: In Imbalanced nutrition, the patient will regain a more normal elimination pattern with aid of foods high in roughage, increased fluid intake, and exercise daily (also with the aid of medications). Encourage small, high-calorie, and high-protein snacks and fluids frequently throughout the day and evening if weight loss is noted; minimizes weight loss, constipation, and dehydration. • Option C: In Self-care deficit, the patient will demonstrate progress in the maintenance of adequate hygiene and be appropriately groomed and dressed (shave/makeup, clothes clean and neat). Encourage the use of soap, washcloth, toothbrush, shaving equipment, make-up etc. Give step-by-step reminders such as “Brush the teeth “Clean the outer surfaces of your upper teeth, then your lower teeth. . .” Slowed thinking and difficulty concentrating make organizing simple tasks difficult. • Option D: In Deficient Knowledge, the patient and significant other will verbalize accurate information about at least two of the possible causes of depression, three-four of the signs and symptoms of depression, and use of medications, psychotherapy, and electroconvulsive therapy as treatment. 21. 21. Question A depressed client is ready for discharge. The nurse feels comfortable that the client has a good understanding of the disease process when the client states: • A. “I’ll never let this happen to me again. I won’t let my boss or my job or my family get to me!” • B. “It’s important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I’ve got to get in to see my doctor.” • C. “I’ve learned that I’m a good person and that I am worthy of giving and receiving love. I don’t need anyone; I have myself to rely on!” • D. “I don’t know what happened to me. I’ve always been able to make decisions for myself and for my business. I don’t ever want to feel so weak or vulnerable again!” Incorrect Correct Answer: B. “It’s important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I’ve got to get in to see my doctor.” The exact cause of depression is not known but is believed to be related to the biochemical disruption of neurotransmitters in the brain. Diet, exercise, and medication are recognized treatments for the disease process. Nursing care plan goals for patients with major depression include determining a degree of impairment, assessing the client’s coping abilities, assisting the client to deal with the current situation, providing for meeting psychological needs, and promoting health and wellness. • Option A: The patient should be able to identify two unrealistic self-expectations and reformulate more realistic life goals with a nurse by the end of the day. The patient will demonstrate a zest for life and ability to enjoy the present, and identify one or two strengths by the end of the day. • Option C: The patient will be able to verbalize that he/she enjoys interacting with others in activities and one-on-one interactions to the extent they did before becoming depressed. The patient will state and demonstrate progress in the resumption of sustaining relationships with friends and family members within one month. • Option D: The patient will be able to identify negative thoughts and rationally counter them and/or reframe them in a positive manner within 2 weeks. He will remember to keep appointments, attend activities, and attend to grooming with minimal reminders from others within 1 to 3 weeks. 22. 22. Question The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse’s immediate intervention is the client’s: • A. Outlandish behaviors and inappropriate dress. • B. Grandiose delusions of being a royal descendant of King Arthur. • C. Nonstop physical activity and poor nutritional intake. • D. Constant, incessant talking that includes sexual innuendos and teasing the staff. Incorrect Correct Answer: C. Nonstop physical activity and poor nutritional intake. Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. Mania is a period when the mood is predominately elevated, expansive, or irritable. All options reflect a client’s possible symptomatology. Option C, however, clearly presents a problem that compromises one’s physiological integrity and needs to be addressed immediately. • Option A: One of the criteria for diagnosing a manic or hypomanic episode of bipolar disorder is what we call an expansive mood. Individuals with an expansive mood may behave rashly or lavishly, assume a superior or grandiose attitude, or dress and act flamboyantly. They exhibit larger-than-life behaviors that can often be accompanied by (or result in) extreme bursts of irritability. • Option B: A delusion of grandeur is the false belief in one’s own superiority, greatness, or intelligence. People experiencing delusions of grandeur do not just have high self-esteem; instead, they believe in their own greatness and importance even in the face of overwhelming evidence to the contrary. Someone might, for example, believe they are destined to be the leader of the world, despite having no leadership experience and difficulties in interpersonal relationships. Delusions of grandeur are characterized by their persistence. They are not just moments of fantasy or hopes for the future. • Option D: The defining characteristics of mania are increased talkativeness, rapid speech, decreased the need for sleep (unlike depression or anxiety in which the need for sleep exists, but there is an inability to sleep), racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation. Some other hallmarks of mania are an elevated or expansive mood, mood lability, impulsivity, irritability, and grandiosity. 23. 23. Question The nurse reviews the activity schedule for the day and plans which activity for the manic client? • A. Brown-bag luncheon and book review • B. Tetherball • C. Paint-by-number activity • D. Deep breathing and progressive relaxation group Incorrect Correct Answer: B. Tetherball A person who is experiencing mania is overactive and full of energy, lacks concentration, and has poor impulse control. The client needs an activity that will allow the use of excess energy yet not endanger others during the process. Tetherball is an exercise that uses the large muscle groups of the body and is a great way to expand the increased energy that the client is experiencing. • Option A: Decreasing environmental stimulation may assist the client to relax; the nurse must provide a quiet environment without noise, television, and other distractions; finger foods or things the client can eat while moving around are the best options to improve nutrition. • Option C: The nurse can direct their need for movement into socially acceptable, large motor activities such as arranging chairs for a community meeting or walking. Clients with mania have short attention spans, so the nurse uses simple, clear sentences when communicating; they may not be able to handle a lot of information at once, so the nurse breaks information into many small segments. • Option D: Deep breathing and progressive relaxation group are a relatively sedated activity that requires concentration, a quality that is lacking in the manic state. Such activities lead to increased frustration and anxiety for the client. A primary nursing responsibility is to provide a safe environment for the client and others; for clients who feel out of control, the nurse must establish external controls emphatically and nonjudgmentally. 24. 24. Question A hospitalized client is being considered for ECT. The client appears calm, but the family is anxious. The client’s mother begins to cry and states “My son’s brain will be destroyed. How can the doctor do this to him?” The nurse’s best response is: • A. “It sounds as though you need to speak with the psychiatrist” • B. “Your son has decided to have this treatment. You should be supportive of him.” • C. “Perhaps you’d like to see the ECT room and speak to the staff.” • D. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.” Incorrect Correct Answer: D. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.” The nurse encourages the client and the family to verbalize fears and concerns. Today ECT is now frequently used to treat a variety of mental health disorders besides depression. The procedure is relatively safe and does work. However, the delivery of ECT requires an interprofessional team that includes a nurse, anesthesiologist, psychiatrist, and neurologist. The benefits of ECT are seen after several sessions and the results are durable. The key is to educate the patient and family about ECT because the procedure has been associated with many false and illogical beliefs. • Option A: ECT is a relatively safe and low-risk procedure that is helpful in the treatment of depression, suicidality, severe psychosis, food refusal secondary to depression, and catatonia. It requires interprofessional care coordination among anesthesiologists, psychiatrists, and nurses. Most patients require several sessions to see a durable effect. The stigma associated with ECT is largely due to the lack of anesthesia with early treatments resulting in significant injury and severe memory loss. • Option B: In a patient under intravenous sedation or general anesthesia, electroconvulsive therapy (ECT) uses an electric current to create a generalized cerebral seizure. Although it is primarily utilized to treat patients with severe depression, patients with schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, and bipolar disorder may also benefit. However, the practice has a stigma attached to it due to misinformation regarding procedural methodology. • Option C: The other options avoid dealing with concerns and are blocked to communication. A complete history and physical examination may expose significant risk factors including cardiac ischemia or arrhythmia, heart failure, or intracranial pathology. History should also include the use of herbal medications such as Ginkgo biloba, ginseng, St. John’s wort, valerian, and kava, all of which may interfere with ECT. There is a risk of status epilepticus in patients on theophylline. Short-acting intravenous beta-blockers may reduce ECT-related hypertension and tachycardia, but may also shorten seizure duration and reduce ECT efficacy. 25. 25. Question The manic client announces to everyone in the dayroom that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to: • A. With assistance, escort the manic client to her room and administer Haldol as prescribed if needed. • B. Tell the client that smoking privileges are revoked for 24 hours. • C. Orient the client to time, person, and place • D. Tell the client that the behavior is not appropriate. Incorrect Correct Answer: A. With assistance, escort the manic client to her room and administer Haldol as prescribed if needed. The client is at risk for injury to self and others and therefore should be escorted out of the dayroom. Antipsychotic medications are useful to manage the manic client. Hyperactive and agitated behavior usually responds to Haldol. Alert staff if a potential for seclusion appears imminent. Usual priority of interventions would be: firmly setting limits; chemical restraints (tranquilizers); and seclusions. • Option B: Option B may increase the agitation that already exists in this client. Remain neutral as possible; Do not argue with the client. The client can use inconsistencies and value judgments as justification for arguing and escalating mania. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for the client’s manipulation of staff. • Option C: Orientation will not halt the behavior. Use a calm and firm approach. Provides structure and control for a client who is out of control. Use short, simple, and brief explanations or statements. Short attention span limits understanding to small pieces of information. Chart, in nurse’s notes, behaviors; interventions; what seemed to escalate agitation; what helped to calm agitation; when as-needed (PRN) medications were given and their effect; and what proved most helpful. • Option D: Telling the client that the behavior is not appropriate already has been attempted by the nurse. Decrease environmental stimuli (e.g., by providing a calming environment or assigning a private room); helps decrease escalation of anxiety and manic symptoms. 26. 26. Question Which of the following nursing interventions is applicable for a hospitalized client with mania who is exhibiting manipulative behavior. Select all that apply. • A. Communicate expected behaviors to the client. • B. Enforce rules and inform the client that he or she will not be allowed to attend group therapy sessions. • C. Ensure that the client knows that he or she is not in charge of the nursing unit. • D. Be clear with the client regarding the consequences of exceeding limits set regarding behavior. • E. Assist the client in testing out alternative behaviors for obtaining needs. Incorrect Correct Answers: A, D, & E Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding limits set; following through with the consequences in a non-punishment manner; and assisting the client in identifying strengths and in testing out alternative behaviors for obtaining needs. Decrease environmental stimuli (e.g., by providing a calming environment or assigning a private room). • Option B: Enforcing rules and informing the client that he or she will not be allowed to attend group therapy sessions is a violation of the client’s rights. Remain neutral as possible; Do not argue with the client. The client can use inconsistencies and value judgments as justification for arguing and escalating mania. • Option C: Ensuring the client knows that he or she is not in charge of the nursing unit is inappropriate, power struggles need to be avoided. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for the client’s manipulation of staff. 27. 27. Question A woman comes into the ER in a severe state of anxiety following a car accident. The most appropriate nursing intervention is to: • A. Remain with the client. • B. Put the client in a quiet room. • C. Teach the client deep breathing. • D. Encourage the client to talk about their feelings and concerns. Incorrect Correct Answer: A. Remain with the client. If a client with severe anxiety is left alone; the client may feel abandoned and become overwhelmed. Remain with the client at all times when levels of anxiety are high (severe or panic); reassure the client of his or her safety and security. The client’s safety is an utmost priority. A highly anxious client should not be left alone as his anxiety will escalate. • Option B: Placing the client in a quiet room is also important, but the nurse must stay with the client. Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.) Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked. • Option C: Teaching the client deep breathing or relaxation is not possible until the anxiety decreases. Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth. Relaxation exercises are effective nonchemical ways to reduce anxiety. • Option D: Encouraging the client to discuss concerns and feelings would not take place until the anxiety has decreased. Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated. Early detection and intervention facilitate modifying a client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety. 28. 28. Question When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. The most appropriate maintenance goal should focus on which of the following? • A. Continued contact with a crisis counselor. • B. Identifying anxiety-producing situations. • C. Ignoring feelings of anxiety. • D. Eliminating all anxiety from daily situations. Incorrect Correct Answer: B. Identifying anxiety-producing situations. Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated. Early detection and intervention facilitate modifying a client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety. • Option A: Counselors will not be available for all anxiety-producing situations, and this option does