A nurse in a substance abuse clinic is assessing a client who is prescribed disulfiram (Antabuse). The client states he stopped the medication after developing severe nausea and vomiting. Which of the following does the nurse realize is most likely the cause of the client's symptoms?

The client took an overdose of the medication.

The client demonstrated an allergic response to the medication.

The client experienced a common side effect of the medication.

The client consumed alcohol while taking the medication.

Answer and Explanation

The Correct Answer is D

Choice A Reason:

An overdose of disulfiram can cause symptoms such as nausea and vomiting, but it is less likely to be the cause in this scenario. Overdoses typically present with more severe symptoms, including seizures and coma in rare cases¹. The client's symptoms are more consistent with a disulfiram-alcohol reaction.

Choice B Reason:

An allergic response to disulfiram can cause symptoms such as rash, itching, and swelling, but severe nausea and vomiting are not typical allergic reactions². Allergic reactions would also likely present with other symptoms such as difficulty breathing or hives, which are not mentioned in this case.

Choice C Reason:

While nausea and vomiting can be common side effects of disulfiram, the severity described by the client suggests a more significant reaction. Common side effects are usually milder and do not typically cause the client to stop the medication abruptly.

Choice D Reason:

The most likely cause of the client's severe nausea and vomiting is the consumption of alcohol while taking disulfiram. Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, leading to an accumulation of acetaldehyde when alcohol is consumed. This results in unpleasant effects such as severe nausea, vomiting, headache, and flushing. The client's symptoms align with this reaction, making it the most probable cause.

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Correct Answer is C

Explanation

Choice A reason:

The Scale for Assessment of Negative Symptoms (SANS) is primarily used for evaluating negative symptoms in schizophrenia and similar disorders, not cognitive disorders. Negative symptoms include affective flattening, alogia, avolition, anhedonia, and attentional impairment. While some of these symptoms may overlap with cognitive disorders, SANS is not specifically designed for cognitive assessment.

Choice B reason:

The Abnormal Involuntary Movements Scale (AIMS) is used to assess involuntary movements, which are often associated with the use of certain medications, such as antipsychotics. It is not a tool for assessing cognitive function but rather for monitoring potential medication side effects like tardive dyskinesia.

Choice C reason:

The Mental Status Examination (MSE) is a comprehensive assessment tool that evaluates a range of cognitive abilities including orientation, attention, memory, language, and executive functions. It is an appropriate inventory for assessing suspected cognitive disorders as it provides a structured way to evaluate cognitive impairment, which is crucial for diagnosing conditions like dementia.

Choice D reason:

The Brief Patient Health Questionnaire (Brief PHQ) is a screening tool for mental health disorders, particularly depression and anxiety. It is not specifically designed to assess cognitive disorders, although mood disorders can co-occur with cognitive impairment.

A. The client meets his daughter for dinner every week. B. The client joined a bowling league 2 months ago. C. The client exercises at a local health facility 3 days each week. D. The client has kept his partner's closet untouched since her death.

Correct Answer is D

Explanation

Choice A Reason:

Meeting his daughter for dinner every week indicates that the client is maintaining social connections and engaging in regular activities. This behavior is generally considered healthy and adaptive, as it shows the client is seeking support and companionship, which are important aspects of coping with grief.

Choice B Reason:

Joining a bowling league 2 months ago suggests that the client is actively participating in social and recreational activities. This is a positive sign of adaptation and indicates that the client is finding ways to engage with others and enjoy life, which can be beneficial for mental health and well-being.

Choice C Reason:

Exercising at a local health facility 3 days each week demonstrates that the client is taking care of his physical health. Regular exercise is known to have numerous benefits, including reducing symptoms of depression and anxiety, improving mood, and enhancing overall well-being. This behavior is indicative of adaptive coping mechanisms.

Choice D Reason:

Keeping his partner's closet untouched since her death is a sign of maladaptive grief. This behavior suggests that the client is unable to move forward and is holding on to the past in a way that interferes with his ability to adapt to the loss. Maladaptive grief can manifest as an inability to accept the loss, persistent yearning for the deceased, and difficulty engaging in life without the deceased.

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A nurse in a substance abuse clinic is assessing a client who is prescribed disulfiram (Antabuse). The client states he stopped the medication after developing severe nausea and vomiting. Which of the following does the nurse realize is most likely the cause of the client's symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting an older adult client to the unit who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment?

Correct Answer is C

Explanation

A nurse is caring for a client whose partner died five years ago. The nurse recognizes that which of the following findings would indicate the client is experiencing maladaptive grief?

Correct Answer is D

Explanation

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