A nurse is planning care for a client who has a gambling disorder. Which of the following actions should the nurse include in the plan of care?

A. Fatigue: Fatigue is a common symptom of cocaine withdrawal, as the body adjusts to the absence of the stimulant. Clients often feel extremely tired or lethargic during this phase. Depressive symptoms that accompany withdrawal can also contribute to feelings of exhaustion.

B. Hand tremors: Hand tremors are more often seen with alcohol withdrawal or neurological disorders. While tremors can occur in some cases, they are not a typical manifestation of cocaine withdrawal. The focus is more on mood and energy changes.

C. Rapid speech: Rapid speech is a sign of cocaine intoxication, not withdrawal. During withdrawal, clients tend to experience slowed speech and cognitive dulling, not the heightened energy associated with the drug.

D. Seizures: Seizures are more related to cocaine overdose or intoxication, not withdrawal. Withdrawal typically involves mood changes and fatigue rather than physical manifestations like seizures.

Rationale for correct choices:

• Administer metoclopramide 10 mg IM: The client is experiencing nausea and vomiting, and metoclopramide is an antiemetic that can help alleviate these symptoms. Managing nausea is crucial for preventing further dehydration and discomfort, especially as the client is refusing to eat or drink anything and has been vomiting most of the night.
• Administer diazepam 10 mg PO: Diazepam is a benzodiazepine used to manage alcohol withdrawal symptoms, such as anxiety and the risk of seizures. It should be administered to prevent severe withdrawal symptoms and ensure the client’s safety, once nausea is managed.

Rationale for incorrect choices:

• Offer ice chips and fluids: While ice chips may help with hydration, the priority is to address the nausea and alcohol withdrawal symptoms first. Administering metoclopramide is the first step to manage nausea, making fluid intake more tolerable.
• Do a CBC and basic metabolic profile: These tests are important for monitoring the client’s condition but are not as urgent as managing nausea and alcohol withdrawal symptoms. These tests should be completed once the acute symptoms are addressed.
• Perform alcohol use disorders identification test (AUDIT): The AUDIT is useful for assessing the severity of alcohol use disorder, but it is not an immediate priority. Managing the client's physical symptoms takes precedence before conducting assessments.
• Begin substance use group therapy: Group therapy is an essential part of treatment but should not be initiated before addressing the client’s immediate physical needs, particularly nausea and alcohol withdrawal symptoms.