NUR 253-256 Answer Key Exam 4

Exam 4 NCLEX-style practice questions Unit 9 (Substance-related and eating disorders), Unit 10 (Violence, sexual assault, abuse, and special populations), and Units 11/12 (Death, dying, and grieving). Unit 9: Substance Related & Eating Disorders Source Focus: Substance disorders, Anorexia, Bulimia, Binge-eating, Alcohol/Opioid withdrawal. 1. A nurse is caring for a client admitted with alcohol withdrawal. Which assessment finding indicates the client is experiencing late-stage withdrawal (delirium tremens)? A. Fine tremors of the hands B. Nausea and vomiting C. Agitation and fluctuating consciousness/hallucinations D. Anxiety and insomnia Answer: C. Rationale: While tremors and anxiety are early signs, delirium tremens is a medical emergency characterized by severe agitation, hallucinations, and fluctuating levels of consciousness. 2. A client is admitted to the ED with an opioid overdose. Which intervention is the priority? A. Administer methadone. B. Assess for suicidal ideation. C. Administer naloxone (Narcan). D. Begin the CIWA assessment protocol. Answer: C. Rationale: The syllabus identifies opioid withdrawal and substance use as key topics. In an overdose, the priority is reversing respiratory depression using naloxone. 3. A nurse is assessing a client with anorexia nervosa. Which physical symptom is the nurse most likely to observe? A. Erosion of dental enamel B. Lanugo (fine downy hair) C. Warm, flushed skin D. Tachycardia Answer: B. Rationale: Lanugo is a classic physiological response to starvation and loss of body fat seen in anorexia nervosa. Enamel erosion is associated with bulimia. 4. A client with bulimia nervosa is being treated in an outpatient setting. Which laboratory result is of most concern to the nurse? A. Potassium 2.9 mEq/L B. Sodium 140 mEq/L C. Hemoglobin 13 g/dL D. Glucose 85 mg/dL Answer: A. Rationale: Bulimia involves purging behaviors (vomiting/laxatives) which lead to electrolyte imbalances, specifically hypokalemia, putting the client at risk for cardiac arrhythmias. 5. Which statement by a client with alcohol use disorder indicates the defense mechanism of denial? A. "I know I drink too much, but I can't stop." B. "I only drink on weekends to relax, I don't have a problem." C. "My wife is the reason I drink; she nags me constantly." D. "I lost my job because I was hungover." Answer: B. Rationale: Denial involves refusing to acknowledge the existence or severity of a problem. Blaming the wife (C) is projection. 6. A nurse is planning care for a client with binge-eating disorder. Which nursing diagnosis is most appropriate? A. Imbalanced nutrition: less than body requirements B. Risk for fluid volume deficit C. Imbalanced nutrition: more than body requirements D. Ineffective airway clearance