A nurse is caring for a client who has been brought into an emergency department of a large hospital. The client's family state that the client 'took some kind of drugs.' The client is dizzy, has recently vomited, and is experiencing paranoia, yelling, 'Stay away from me! You are going to kill me!' The client alternates yelling with mumbling and gesturing. Their eyes are darting back and forth as they are talking to the wall. The nurse should suspect the client has used which of the following substances?

Correct Answer: D

Rationale: In this scenario, the nurse should suspect that the client has used hallucinogens. Hallucinogens such as LSD, psilocybin, or PCP can cause symptoms like paranoia, hallucinations, disorientation, and erratic behavior, which align with the client's presentation. These substances can lead to altered perceptions of reality and severe psychological distress, explaining the client's behavior of yelling, paranoia, and gesturing at unseen entities. Regarding the other options: A) Anabolic steroids: Anabolic steroids do not typically cause the acute behavioral symptoms described in the client. They are more associated with physical effects like muscle growth. B) Opioids: While opioids can cause altered mental status, they are more likely to result in sedation, respiratory depression, and pinpoint pupils rather than the hallucinatory symptoms exhibited by the client. C) Stimulants: Stimulants like cocaine or amphetamines can induce paranoia and agitation, but they are less likely to cause the vivid hallucinations and perceptual disturbances observed in this case. Understanding the effects of different substances on behavior is crucial for nurses in emergency settings to provide appropriate and timely care. Recognizing the signs of hallucinogen use can guide the nurse in managing the client's safety, addressing their psychological distress, and ensuring proper medical intervention. This knowledge aids in conducting a thorough assessment, implementing relevant interventions, and promoting a safe and supportive environment for individuals experiencing substance-related issues.

Correct Answer: A

Rationale: In clients with dependent personality disorder, the correct finding is that they are fearful of making decisions (Option A). This is because individuals with this disorder typically have an excessive need to be taken care of, which leads to a lack of confidence in their abilities to make decisions independently. This fear of making decisions can manifest in various aspects of their lives, from daily choices to significant life decisions. Options B, C, and D are incorrect for clients with dependent personality disorder. Option B, erratic behaviors, is more commonly associated with conditions like borderline personality disorder or certain mood disorders. Option C, dramatic behaviors, are characteristic of histrionic personality disorder. Option D, easily expressing disagreement with others, is not typical for individuals with dependent personality disorder, as they often avoid conflict and seek approval from others to maintain their sense of security and reliance. Educationally, understanding the specific characteristics and common findings associated with different personality disorders is crucial for nurses in planning effective care. By recognizing these distinctions, nurses can tailor interventions and support strategies to meet the unique needs of clients with various personality disorders, promoting better outcomes and enhancing the therapeutic relationship.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Alzheimer's disease. Cortical thinning is a characteristic feature of Alzheimer's disease, a type of dementia that primarily affects areas of the brain responsible for memory, thinking, and language. This thinning is due to the degeneration and loss of nerve cells in the cerebral cortex over time. Option A) Prion disease is characterized by the accumulation of abnormal prion proteins in the brain, leading to rapid neurological deterioration, but it does not typically present with cortical thinning as seen in Alzheimer's disease. Option C) Substance use disorder primarily affects brain function through the effects of substances on neurotransmitter systems and neural pathways, rather than cortical thinning. Option D) HIV infection can lead to neurocognitive disorders, but cortical thinning is not a typical feature of HIV-related brain changes. Educationally, understanding the specific brain changes associated with different types of dementia is crucial for nurses caring for patients with cognitive impairments. Recognizing cortical thinning as a hallmark of Alzheimer's disease can aid in early detection, appropriate care planning, and effective communication with the healthcare team and family members.

Correct Answer: D

Rationale: The correct answer is D) The fear of abandonment associated with progress toward autonomy and independence. This is the likely trigger for the self-inflicted wrist lacerations in a patient with borderline personality disorder. Individuals with this disorder often have intense fears of abandonment and struggle with feelings of insecurity and instability in relationships. As the patient gains new privileges and moves towards autonomy, the fear of being abandoned or rejected can trigger self-destructive behaviors as a way to cope with overwhelming emotions. Option A) An inherited disorder that manifests itself as an incapacity to tolerate stress, while stress intolerance can be a component of borderline personality disorder, it does not directly address the trigger of abandonment fears. Option B) The use of projective identification and splitting to bring anxiety to manageable levels refers to defense mechanisms that individuals with borderline personality disorder may use, but this does not directly explain the trigger for the self-mutilation. Option C) A constitutional inability to regulate affect, predisposing to psychic disorganization addresses a characteristic of borderline personality disorder but does not specifically link it to the trigger of fear of abandonment. Educationally, understanding the triggers for self-destructive behaviors in individuals with borderline personality disorder is crucial for nurses to provide effective care and support. By recognizing the underlying fears and insecurities, nurses can implement strategies to help patients cope with their emotions and develop healthier ways of managing distress.

Correct Answer: B

Rationale: In this case, option B, "Moving to three new homes over a 2-year period," would prompt the nurse to carefully assess the 8-year-old child for the development of a psychiatric disorder. This option indicates a significant life stressor that can impact a child's mental health. Frequent relocations can disrupt a child's sense of stability, leading to feelings of insecurity, anxiety, and difficulty in forming secure attachments. Option A, "Being raised by a parent with chronic major depressive disorder," is a risk factor for the child to develop psychiatric issues, but it does not necessarily indicate immediate need for assessment in the child. Option C, "Not being promoted to the next grade," is a common stressor for children but is not directly linked to the development of a psychiatric disorder. Option D, "Having an imaginary friend," is a normal part of child development and does not inherently suggest a psychiatric disorder. In an educational context, it is crucial for nurses to understand the impact of environmental stressors on children's mental health. By recognizing significant life events like multiple relocations, nurses can intervene early to support the child's emotional well-being and prevent the escalation of mental health issues. Understanding the nuances of childhood development and the influence of environmental factors is essential for providing holistic and effective behavioral health nursing care.