Question 1

The nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance use disorder?

A) Narcotic pain medication is contraindicated for all clients with active substance use problems.
B) Clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control.
C) There is no need to assess the client for substance use disorder. There is an obvious PCA malfunction.
D) The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

Clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control.

Accepted Answer

1.This is incorrect. Narcotic pain medication may be used when needed for clients with active substance abuse problems; however, the client must be monitored carefully and the dosing adjusted appropriately.
2.This is correct. Cross-tolerance occurs when one drug lessens an individual's response to another drug. Clients who are regularly using alcohol or benzodiazepines have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control.
3.This is incorrect. Clients who are regularly using alcohol or benzodiazepines have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. This client is demonstrating behaviors that suggest possible substance abuse due to the numerous attempts to receive pain medication.
4.This is incorrect. The scenarios does not suggest symptoms of withdrawal; rather, the client demonstrates behaviors that demonstrate possible cross-tolerance.

Question 2

Which of the following nursing statements exemplifies important insights to promote effective intervention with clients diagnosed with substance use disorders? Select all that apply.&#10;A) &#34;I am easily manipulated and need to work on this prior to caring for these clients.&#34;&#10;B) &#34;Because of my parent's alcoholism, I need to examine my attitude toward these clients.&#34;&#10;C) &#34;Drinking is legal, so the diagnosis of substance use disorder is an infringement on client rights.&#34;&#10;D) &#34;Opioid addicts are typically uneducated, unrefined individuals who will need a lot of education and social skills training.&#34;&#10;E) &#34;I can fix clients diagnosed with substance use disorders as long as I truly care about them.&#34;&#10;

Accepted Answer

1.This is correct. The nurse must examine their feelings about working with clients diagnosed with substance use disorders. The role alcohol or other substances have played (or play) in the life of the nurse will affect the way in which they interact with a client who has a substance use disorder. The nurse who recognizes being easily manipulated will be able to examine their feelings and abilities to work with substance abuse clients.
2.This is correct. The nurse must examine their feelings about working with clients diagnosed with substance use disorders. The role alcohol or other substances have played (or play) in the life of the nurse will affect the way in which they interact with a client who has a substance use disorder.
3.This is incorrect. The nurse who identifies a diagnosis of substance abuse being an infringement on client rights does not promote effective intervention or insights to the issues experienced by clients.
4.This is correct. The nurse must examine their feelings about working with clients diagnosed with substance use disorders. Unless nurses fully understand and accept their own attitudes and feelings, they cannot be empathetic toward clients' problems. Nurses must be able to separate the client from the behavior and accept the client with unconditional positive regard.
5.This is incorrect. Many health-care workers who were reared in homes with a chemically addicted person are at risk for activation of unresolved codependent tendencies. Nurses who assumed the "fixer" role in their dysfunctional families of origin during childhood may attempt to resume that role in their caregiving professions.

Question 3

Which student statement indicates that learning has occurred regarding risk factors for the development of delirium in older adults?&#10;A) &#34;Taking multiple medications may lead to adverse interactions or toxicity.&#34;&#10;B) &#34;Age-related cognitive changes may lead to alterations in mental status.&#34;&#10;C) &#34;Lack of rigorous exercise may lead to decreased cerebral blood flow.&#34;&#10;D) &#34;Decreased social interaction may lead to profound isolation and psychosis.&#34;&#10;

Accepted Answer

1.This is correct. Taking multiple medications may lead to adverse reactions or toxicity and put an older adult at risk for the development of delirium. Symptoms of delirium include difficulty sustaining and shifting attention, impaired memory, and confusion (disorientation to time and place).
2.This is incorrect. Age-related cognitive changes do not lead to delirium.
3.This is incorrect. Lack of rigorous exercise does not lead to a decrease in cerebral blood flow.
4.This is incorrect. Decreased social isolation does not lead to profound isolation and psychosis; an increase in isolation does this.

Question 4

A nursing instructor is teaching about donepezil. A student asks, &#34;How does this work? Will this cure Alzheimer's disease?&#34; Which reply by the instructor is appropriate?&#10;A) &#34;Donepezil delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.&#34;&#10;B) &#34;Donepezil encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.&#34;&#10;C) &#34;Donepezil delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.&#34;&#10;D) &#34;Donepezil encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.&#34;&#10;

Accepted Answer

1.This is correct. Donepezil slows the progression of Alzheimer's disease by inhibiting acetylcholinesterase, which delays the destruction of the neurotransmitter acetylcholine, which is necessary for memory processes.
2.This is incorrect. Donepezil does not encourage production of acetylcholinesterase; rather, it inhibits the production.
3.This is incorrect. Donepezil does not delay the destruction of dopamine.
4.This is incorrect. Donepezil does not encourage the production of dopamine, but inhibits acetylcholinesterase.

Question 5

Which nursing student statement requires further teaching regarding care for the client with NCD experiencing hallucinations?&#10;A) &#34;I will assess for side effects of medications that could cause hallucinations.&#34;&#10;B) &#34;My client wears a hearing aid. I need to ensure it is working properly.&#34;&#10;C) &#34;If I am not experiencing the hallucination, then it is likely the client is not either.&#34;&#10;D) &#34;I took the mirror off the wall because the client was seeing a false image.&#34;&#10;

Accepted Answer

1.This is incorrect. Assessing for side effects of medications that could cause hallucinations is an appropriate action, and no further teaching is required.
2.This is incorrect. If a hearing aid is working incorrectly and transmitting faulty sounds, it can cause delusions/hallucinations. This action is correct and does not require further teaching.
3.This is correct. This statement requires further teaching. Just because the student cannot see or hear what the client sees or hears does not mean it is not real to the client.
4.This is incorrect. This action is correct and does not require further teaching. Clients will often see false images in photographs and mirrors. If they are causing distress to the client, they should be removed.

Question 6

A client diagnosed with an NCD due to late-stage Alzheimer's disease is incapable of performing ADLs. Which intervention is the nurse's priority?&#10;A) Present evidence of objective reality to improve cognition.&#10;B) Design a bulletin board to represent the current season.&#10;C) Label the client's room with name and number.&#10;D) Assist the client with bathing and toileting.&#10;

Accepted Answer

1.This is incorrect. If the client is in the stage where they are unable to perform ADLs, the client is past the stage where cognition will improve.
2.This is incorrect. If the client is in the stage where they are unable to perform ADLs, then the client is past the stage where cognition will improve, so designing a bulletin board with the current season will not be beneficial for them.
3.This is incorrect. If the client is in the stage where they are unable to perform ADLs, then the client is past the stage where cognition will improve, so labeling the client's room with their name and number will not be beneficial for them.
4.This is correct. The nurse's priority is to assist with bathing and toileting. A client who is incapable of performing ADLs requires assistance in these areas to ensure health and safety.

Question 7

Which action would the nurse take to promote safety in the client with an NCD?&#10;A) Keep the client in the room furthest from the nurse's station.&#10;B) Provide the client with glass items instead of disposable items.&#10;C) Keep the bed in high position.&#10;D) Encourage the client to call for assistance when getting out of bed.&#10;

Accepted Answer

1.This is incorrect. The client should be kept in a room closest to the nurse's station.
2.This is incorrect. The client should not be provided with glass items, razors, or flammable items.
3.This is incorrect. The bed should be kept in lowest position.
4.This is correct. The client should be instructed to call the nurse for assistance when getting out of bed.

Question 8

A 36-year-old is admitted to the emergency department at 2:20 a.m. with a severe laceration to her forehead and incoherent speech. Paramedics report that they picked up the client at a local bar, and the bartender onsite said, "She seemed just fine when she came in. She must have had a lot to drink before she came here." Witness reports onsite confirmed that the woman fell off a bar stool and hit her head on the bar rail. Based on the information provided, a blood alcohol test was administered, and her blood alcohol content was 0.01%. The client's weight was recorded at 145 lbs. Incoherent speech is most likely attributed to which of the following?

A) Alcohol intoxication
B) Intoxication and fatigue due to the late hour
C) A primary NCD
D) A secondary NCD

Accepted Answer

1.This is incorrect. Intoxication from drugs and/or alcohol could cause the instability and lack of balance to fall as well as the incoherent speech; however, the blood alcohol level of 0.01 is very unlikely to cause impairment.
2.This is incorrect. Intoxication and fatigue could cause instability and lack of balance, resulting in a fall, as well as incoherent speech. However, the blood alcohol level of 0.01 is very unlikely to cause impairment, and there is no reason to suspect fatigue, other than the late hour she was picked up by paramedics.
3.This is incorrect. Given the scenario, the information provided does not indicate that any preexisting primary NCD was present.
4.This is correct. The blood alcohol content of 0.01% and reports of the client's behavior prior to the fall indicate a likelihood of cerebral trauma associated with the fall.

Question 9

The nurse notices that Martha, the primary caregiver for her spouse with Alzheimer's disease, seems distracted, and she asks how Martha is doing. "I'm doing OK," said Martha. "I'm just so overwhelmed. I can't seem to get anything done. Just when I think I'm handling everything, something else comes up. Hopefully things will settle down soon, and I can get a break." Which intervention would most help Martha cope with the caregiver strain she's expressing?

A) Teaching about symptoms of Alzheimer's disease
B) Information about the management of Alzheimer's disease
C) Referrals to support services for Alzheimer's disease
D) Recommending an Alzheimer's-friendly residence facility

Accepted Answer

1.This is incorrect. Teaching Martha about the symptoms of Alzheimer's disease will not help with caregiver strain.
2.This is incorrect. Learning more about the management of Alzheimer's disease will not help with caregiver strain.
3.This is correct. There are several support services available for caregivers of clients with Alzheimer's disease. These include financial assistance, legal assistance, caregiver support groups, respite care, and home health care. All of these support services would help Martha deal with the caregiver strain she is experiencing.
4.This is incorrect. Although relocating Martha's spouse may ease the strain she is experiencing, it may not be necessary and could add additional strain in terms of finances, guilt, travel, and so forth.

Question 10

The nurse is caring for an older adult client with an NCD who becomes agitated. Which intervention by the nurse is appropriate? Select all that apply.&#10;A) Demand the client attend a group activity session.&#10;B) Administer an antipsychotic medication as prescribed.&#10;C) Restrain the client immediately.&#10;D) Encourage doll therapy.&#10;E) Attempt to reason with the client.&#10;F) Perform relaxation techniques.&#10;

Accepted Answer

1.This is incorrect. When a client is agitated, the nurse should not be demanding of the client. This can cause further agitation.
2.This is correct. Antipsychotics can help reduce agitation.
3.This is incorrect. Restraints should be used as a last resort. Other interventions should be tried first.
4.This is correct. According to the literature, doll therapy has been shown to improve mood and reduce agitation.
5.This is incorrect. Attempting to reason with the client can make agitation worse.
6.This is correct. Performing relaxation techniques can help reduce agitation.

Question 11

A client in stage 3 Alzheimer's disease frequently wanders. Which interventions can the nurse implement to reduce the incidence of wandering and promote safety? Select all that apply.&#10;A) Keep the client on a strict toileting schedule.&#10;B) Allow the client a large, unrestricted area to wander.&#10;C) Walk with the individual and redirect them back to the unit.&#10;D) Ensure the exits are not electronically controlled.&#10;E) Keep the client on a structured schedule of activities.&#10;

Accepted Answer

The answer of A client in stage 3 Alzheimer's disease...

Question 12

____________________ is the inability to perform motor activities despite intact motor function.&#10;A) Apraxia&#10;B) Aphasia&#10;C) Dementia&#10;D) Delirium&#10;

Accepted Answer

The answer of ____________________ is the inability to perform motor...

Deck 9: Substance-Related and Addictive Disorders