Ch. 31 Substance Use Disorders

1. A pregnant patient experiencing insomnia reports taking diazepam and wine in increasing amounts to be able to sleep. The nurse should teach the patient about what risk associated with this habit? a. Central nervous system (CNS) depression b. Acetaldehyde toxicity c. Fetal alcohol syndrome d. Miscarriage

ANS: A Alcohol ingested with another CNS depressant can produce lethal depressant effects. The other options are not relevant based on the information given in the scenario nor the effects of combining the medication and alcohol.

1. An individual experiencing a heroin overdose has been given one dose of naloxone intravenously. What the priority nursing intervention is to assure patient safety? a. Close observation to determine the need for an additional dose of naloxone b. Seizure precautions for 2 hours immediately after administration of naloxone c. Acidification of urine by encouraging the patient to drink cranberry juice d. A nonstimulating environment and administration of oral fluids

ANS: A Naloxone, a narcotic antagonist, permits the individual to respond and respirations to improve. However, because most opioids have a longer lasting effect than naloxone, the effects of naloxone will wear off before the effects of the opioid. The administration of naloxone might have to be repeated. If it is not, the individual is in danger of death due to respiratory depression. None of the remaining options would support client safety when considering the effects of a heroin overdose.

1. The nurse suspect that a patient has developed a tolerance for alcohol. Which patient statement supports that suspicion? says, The nurse assesses this phenomenon as related to: a. "I felt good from drinking a six-pack a few months ago. Now I need a few extra cans to get the same high." b. withdrawal. c. co-dependency. d. abstinence syndrome.

ANS: A Tolerance refers to the need for increasing amounts of a substance to achieve the same effects. The other terms are not related to needing more of a substance to achieve the same effect.

1. A patient diagnosed with Wernicke-Korsakoff syndrome has the nursing diagnosis impaired memory, related to neurotoxicity of alcohol. Which statement made by the patient confirms the presences of a defining characteristic that applies to this diagnosis? a. "I sometimes make up a story to cover up for something I can't remember." b. "I often hear voices that others claim they don't hear." c. "All of a sudden, I'll have a vivid memory of the accident that killed my son." d. "Regardless of what you say, I know that the mob or CIA is out to kill me."

ANS: A Wernicke-Korsakoff syndrome is a mental disorder characterized by amnesia, clouding of consciousness, confabulation (falsification of memory) and memory loss, and peripheral neuropathy. Confabulation is a symptom typically displayed by an individual with Wernicke-Korsakoff syndrome. The individual attempts to make up for memory loss by filling in the blanks with false memories. Auditory hallucinations are often described as hearing voices that no one else can hear. Paranoid delusions are characterized by an unrealistic or unsubstantiated belief that one is in danger. None of these options are symptoms of memory impairment associated with Wernicke-Korsakoff syndrome.

1. How is substance dependence best defined? (Select all that apply.) a. A compulsion to use a substance b. Loss of control over use of a substance c. A physiological need to use a substance d. Continued use of a substance despite adverse consequences e. A substance-specific syndrome due to recent ingestion of a substance

ANS: A, B, C, D Dependence is marked by multiple criteria defined in the DSM-V. A substance-specific syndrome due to recent ingestion of the substance refers to substance intoxication.

1. Naltrexone is prescribed for a patient diagnosed with alcohol dependency. What information should the nurse provide to the patient? (Select all that apply.) a. "This medication is part of a total program to help you remain abstinent from alcohol." b. "Do not use alcohol-containing products, such as aftershave lotion and mouthwash." c. "Avoid foods that contain tyramine, such as aged cheeses and meats." d. "This medication will help reduce the likelihood of a relapse." e. "This medication will eliminate your desire for alcohol."

ANS: A, D Naltrexone, like any drug for treatment of chemical dependence, is only part of a total treatment program. It will help decrease the pleasure associated with alcohol, but it will not eliminate the desire. It reduces craving, which in turn will help reduce the likelihood of relapses. The distracters relate to disulfiram and monoamine oxidase inhibitors.

1. The nurse should assure that the milieu for a patient admitted for a hallucinogen overdose should have which features? (Select all that apply.) a. Focused attention on safety b. Well lighted c. Social interaction d. Mentally challenging e. Low sensory stimuli

ANS: A, E Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

1. What are the most important interventions for the nurse to implement with caring for a client experiencing barbiturate withdrawal? (Select all that apply.) a. Monitoring level of consciousness b. Supporting effective respirations c. Medicating for nausea d. Monitoring for tachycardia e. Seizure precautions

ANS: A, E Delirium and seizures are considered serious withdrawal symptoms requiring seizure precautions and frequent monitoring of levels of consciousness. Nausea may be experienced but is not considered a serious side effect of withdrawal. Depressed respirations and increased heart rate are signs of barbiturate overdose.

1. Which statements accurately portray differences in the effects of alcohol between men and women? (Select all that apply.) a. Women's gastrointestinal systems have less alcohol dehydrogenase, so less ethanol is oxidized on first pass before it enters the bloodstream. b. Hot coffee increases the metabolic rate and speeds oxidation of ethanol more in men than in women. c. Women have higher proportions of body fat, which absorbs alcohol and releases it slowly. d. The microsomal ethanol-oxidizing system in women is less efficient than in men. e. Women become intoxicated more easily than men.

ANS: A, E The alcohol dehydrogenase in the gastrointestinal tissue of men who are not dependent on alcohol oxidizes a significant amount of CH3CH2OH in the gut before it enters the bloodstream. The inability of women's bodies to undergo this first-pass metabolism accounts for their enhanced vulnerability to alcohol. The remaining options do not reflect accurate research findings.

1. A patient asks, "How does Alcoholics Anonymous (AA) work?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be given a sponsor who will plan your treatment program."

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

1. A cocaine abuser complains, "There are bugs crawling under my skin." Which term should the nurse use to document this finding? a. Confabulation b. Formication c. Synesthesia d. Euphoria

ANS: B Formication is the term used when an individual describes feeling bugs crawling under the skin. It is seen in cocaine use. The other options refer to altered sensory perceptions of sight and sound or to inventing stories to make up for memory deficit.

1. A nurse caring for a patient who experienced an opioid overdose will give priority to which focused assessment? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

ANS: B Opioid overdose causes respiratory depression, which is the primary cause of death among opioid abusers. The assessment of the other body systems is not the priority.

1. A patient in the emergency department says, "I took a drug that makes me feel like I'm outside my body looking at the world while making colors move like music." What question should the nurse ask to assess for the possible cause of the patient's experience? a. "Have you ever been diagnosed with schizophreniform disorder?" b. "Did you knowly ingest a hallucinogenic substance?" c. "Are you currently taking an antidepressant?" d. "Have you ever experienced anything like this before?"

ANS: B Symptoms of hallucinogen use (e.g., LSD) include depersonalization, loss of reality, hallucinations, synesthesia, panic, paranoid thinking, and loss of contact with reality and synesthesia, which is the blending of senses (e.g., smelling a color or tasting a sound). Data given in the scenario do not support a schizophreniform disorder or formication (abnormal crawling sensations under the skin). While an appropriate assessment question, determining if this ever happened before doesn't focus on cause.

1. When caring for patients withdrawing from cocaine and amphetamines, the nurse should plan measures recognizing what unique characteristic of this withdrawal process? a. Physical withdrawal is severe and often fatal. b. Psychological withdrawal is more severe than physical. c. Physical and psychological withdrawal are equally severe. d. Physical withdrawal is a problem only if the individual used injection.

ANS: B These drugs are highly addictive. Psychological craving during withdrawal is intense. The physical signs/symptoms of withdrawal, however, are relatively mild. The degree of withdrawal signs/symptoms are not necessarily associated with the route of drug administration.

1. A patient is about to begin detox for an opioid addiction. Which statements by the patient demonstrate an understanding of the signs/symptoms of the withdrawal process? (Select all that apply.) a. "I've been told to expect to be constipated." b. "My nose is going to run like I have a bad cold." c. "My legs are going to spasm painfully." d. "I'll have erection issues for several weeks." e. I'm going to have goose bumps from the chills."

ANS: B, C, E Opioid withdrawal symptoms include yawning, rhinorrhea (runny nose), sweating, chills, piloerection (goose bumps), tremor, restlessness, irritability, leg spasm, bone pain, diarrhea, and vomiting. Sexually erection is not generally affected.

1. A patient has a history of alcohol abuse. Which prescription drug would cause the nurse to be most concerned about of its risk for cross-dependency? a. Hydrochlorothiazide b. Benztropine c. Chlordiazepoxide d. Olanzapine

ANS: C Cross-addiction occurs with CNS depressant drugs. Chlordiazepoxide is a benzodiazepine, so cross-dependence is expected. The other drugs will not produce cross-dependence.

1. Loneliness, related to unacceptable interpersonal behaviors is the nursing diagnosis for a patient in an alcohol rehabilitation program. Which AA step is most directly related to this problem? a. Admitted powerlessness over alcohol b. Turned our lives over to a higher power c. Made amends to persons we had harmed d. Tried to carry the AA principles to alcoholics

ANS: C Steps 8 and 9, making amends, could restore relationships and reduce social isolation from family and former friends. The other steps are less clearly related to this goal.

1. How is a blackout is described? a. A comatose period related to alcohol withdrawal. b. A comatose episode associated with alcohol intoxication and poisoning. c. A time period in which a person who has used alcohol is unresponsive to the environment. d. An episode in which a person under the influence of alcohol functions normally but later is unable to remember.

ANS: D A blackout is defined as a period of time in which a drinker functions socially but for which there is no memory. The distracters omit aspects of a blackout.

1. Which assessment findings would prompt the nurse to suspect a disulfiram reaction? a. Skin rash, itching, and urticaria b. Pallor, hypotension, and muscle cramping c. Dry skin, bradycardia, fatigue, and headache d. Headache, dyspnea, nausea, vomiting, and flushing

ANS: D A disulfiram reaction consists of any combination of the following symptoms: flushing, sweating, rapid pulse, hypotension, throbbing headache, nausea, vomiting, palpitations, dyspnea, tremor, and weakness. The patient is acutely uncomfortable. The other options do not characterize the disulfiram/alcohol reaction.

1. The nurse assesses a patient who admits to abusing large quantities of amphetamines. Assessment findings are likely to be similar to which psychiatric disorder? a. Wernicke-Korsakoff syndrome b. Bipolar disorder, manic phase c. Generalized anxiety disorder d. Paranoid schizophrenia

ANS: D Amphetamines enhance dopamine activity. The psychosis that is induced by amphetamines closely mimics the symptoms of paranoid schizophrenia. The other disorders have less to do with dopamine dysregulation.

1. An unconscious patient is brought to the emergency department with a suspected heroin overdose. Which vital signs support the suspected diagnosis? a. Blood pressure (BP) 200/100 mm Hg; pulse (P) 92 beats/min; respirations (R) 22 breaths/min b. BP 150/85 mm Hg; P 76 beats/min; R 28 breaths/min c. BP 110/70 mm Hg; P 84 beats/min; R 20 breaths/min d. BP 70/40 mm Hg; P 100 beats/min; R 10 breaths/min

ANS: D Heroin is a CNS depressant. It causes respiratory depression and lowered BP, with a compensatory rise in the pulse rate. Only the correct option follows this pattern.

1. During the rehabilitation phase of alcoholism treatment, naltrexone is prescribed. Which statement by the client demonstrates that the medication is achieving. It's intented goal to reduce the pleasurable effects of drinking alcohol. The nurse can expect to teach the patient about what medication? a. "I sleep much better than I have in years." b. "I get really sick if I drink now." c. "I'm not as nervous as I was." d. "I don't crave alcohol like I did."

ANS: D Naltrexone is an opioid receptor antagonist. It compromises the pleasurable effects of alcohol and reduces craving. Naltrexone does not affect sleep or anxiety nor is it an anxiolytic drug that makes drinking uncomfortable.

1. Family members of an individual undergoing a 30-day alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search-and-destroy tactics to keep the home alcohol free." c. "Prevent embarrassment by covering for your loved one's lapses." d. "Make your loved one responsible for the consequences of his or her behavior."

ANS: D Often the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors. Learning to face those consequences is part of the recovery process. The other options are co-dependent behaviors or are of no help.

1. Which assessment findings support a nurse's suspicion that a patient has possibly been abusing inhalants? (Select all that apply.) a. Perforated nasal septum b. Hypertension c. Pinpoint pupils d. Confusion e. Ataxia

ANS: D, E Inhalants are usually CNS depressants, giving rise to confusion and ataxia. The other options relate to cocaine snorting and opioid use.