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The treatment team plans care for a person diagnosed with schizophrenia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning?
- A. Consider each disorder primary and provide simultaneous treatment.
- B. The person will benefit from treatment in a residential treatment facility.
- C. Withdraw the person from cannabis, and then treat the schizophrenia.
- D. Treat the schizophrenia first, and then establish the goals for the treatment of substance abuse.
Correct Answer: A
Rationale: Dual diagnosis guidelines suggest treating both substance and psychiatric disorders as primary with simultaneous treatments.
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During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, 'After discharge, I think everything will be just fine.' Which remark by the nurse will be most helpful to the spouse?
- A. It is good that you're supportive of your spouse's sobriety and want to help maintain it.'
- B. Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol.'
- C. It will be important for you to structure life to avoid as much stress as possible. You will need to provide social protection.'
- D. Remember that alcoholism is a disorder of self-destruction. You will need to observe your spouse's behavior carefully.'
Correct Answer: B
Rationale: This response provides anticipatory guidance about challenges in sobriety, helping the spouse prepare for new issues.
A newly hospitalized patient has needle tracks on both arms. A friend states that the patient uses heroin daily but has not used in the past 24 hours. The nurse should assess the patient withdrawal symptoms?
- A. Slurred speech, excessive drowsiness, and bradycardia
- B. Paranoid delusions, tactile hallucinations, and panic
- C. Runny nose, yawning, insomnia, and chills
- D. Anxiety, agitation, and aggression
Correct Answer: C
Rationale: Early narcotic withdrawal resembles flulike symptoms without fever.
A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats/min. The patient shouts, 'Snakes are crawling on my bed. I've got to get out of here.' What is the most accurate assessment of the situation?
- A. The patient is attempting to obtain attention by manipulating staff.
- B. The patient may have sustained a head injury before admission.
- C. The patient has symptoms of alcohol withdrawal delirium.
- D. The patient is having a recurrence of an acute psychosis.
Correct Answer: C
Rationale: Symptoms of agitation, elevated pulse, and perceptual distortions point to alcohol withdrawal delirium, a medical emergency.
A patient has smoked two packs of cigarettes daily for many years. When the patient does not smoke or tries to cut back, anxiety, craving, poor concentration, and headache result. What does this scenario describe?
- A. Substance abuse
- B. Substance addiction
- C. Substance intoxication
- D. Recreational use of a social drug
Correct Answer: B
Rationale: Nicotine addiction is indicated by compulsive use, craving, tolerance, and withdrawal symptoms.
Select the nursing intervention necessary after administering naloxone to a patient experiencing an opiate overdose.
- A. Monitor the airway and vital signs every 15 minutes.
- B. Insert a nasogastric tube and test gastric pH.
- C. Treat hyperpyrexia with cooling measures.
- D. Insert an indwelling urinary catheter.
Correct Answer: A
Rationale: Naloxone reverses CNS depression, but monitoring is needed as narcotics outlast the antagonist.