Psych Exam 3 - Ch. 22 (Substance-Related & Addictive Disorders)

The patient tells the nurse, "I have been smoking pot for several years to help me sleep, and I want to quit." What statement made by the nurse reflects accurate information?

"You may experience insomnia and disturbing dreams." When people use cannabis as a sleep aid, insomnia and disturbing dreams may ensue without it. Cannabis causes drowsiness and impairs motor skills for eight to ten hours. Antianxiety medications are not prescribed for treatment of cannabis withdrawal. The patient will experience some symptoms after a prolonged use of the drug, even if use has only been at night. p. 414

An appropriate long-term goal/outcome for a recovering substance abuser would be that the patient will

Abstain from the use of mood-altering substances Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. p. 424, Table 22.5

A patient is admitted to the unit for alcohol withdrawal and presents with moderate agitation and tremors. What is the nurse's priority action?

Administer chlordiazepoxide IV. The nurse's priority action is to administer chlordiazepoxide intravenously (IV). Chlordiazepoxide is useful for tremulousness and mild to moderate agitation. IV diltiazem is a calcium channel blocker for hypertension. Diazepam IV is a common treatment for withdrawal seizures. Intramuscular (IM) lorazepam is used for withdrawal in which psychosis is present. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple choice items. If you are uncertain about a question, eliminate the choices you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 420

Which assessment data would be most consistent with a severe opiate overdose?

Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. p. 416, Box 22.1

Cocaine exerts which of the following effects on a patient?

Increased metabolism Cocaine exerts a stimulant effect on metabolism. p. 410, Table 22.1

Which finding indicates that treatment for imbalanced nutrition has been effective for a patient with a history of cannabis abuse?

The patient eats a well-balanced diet. Cannabis use causes abnormal eating patterns that can result in obesity. Therefore, effective treatment should enable the patient to eat a well-balanced diet that provides adequate nutrients to meet the metabolic demands of the body. Patients who have a risk of suicide begin to express feelings after successful therapy. Effective treatment of patients with a risk for injury because of substance use will result in the patient remaining free from injuries. Patients who experience disturbed sleep patterns will begin to sleep well and feel refreshed on awakening in the mornings after treatment. p. 424, Table 22.5

A patient with severe addiction to alcohol plans to undergo a detoxification program. Why is 24-hour professional supervision needed during this process?

To monitor and intervene during the process because there are uncomfortable and even fatal side effects Alcohol withdrawal has many uncomfortable and sometimes fatal side effects. Therefore, detoxification is available as a medically monitored program with 24-hour medical supervision based on the severity of symptoms and the presence of comorbid conditions. Supportive and motivational counseling is a continuous process that starts before the detoxification program and goes on throughout the treatment process. The patient is cut off from any substances he or she might abuse while undergoing detoxification. It is important to monitor that metabolic needs are met, but a 24-hour professional supervision is not needed for that. p. 427

A patient is diagnosed with mouth cancer. Which substance abuse should the nurse inquire about with the patient?

Tobacco Substance use disorders arise from cravings for drugs or other substances and eventually turn to physical addictions. Oral and injection are the common routes of administration. Addiction to tobacco causes disorders like hypertension, chronic lung disorders, and mouth cancer. These symptoms are not seen in cases of opium, alcohol, and cocaine addictions. Addiction to opium may result in constipation, hepatitis, and endocarditis. Addiction to alcohol may result in loss of consciousness, visual distortions, sexual dysfunction, and liver and heart disorders. Addiction to cocaine may result in hypertension. p. 410, Table 22.1

Nursing assessment of an alcohol-dependent patient experiencing uncomplicated moderate alcohol withdrawal would most likely reveal the presence of

Tremors Tremors are a sign of mild to moderate alcohol withdrawal. Hallucinations, seizures and blackouts would indicate complicated or severe ETOH withdrawal. p. 420

Which observation indicates to the nurse that a patient is at risk for codependent behavior?

Values for himself or herself are based on self-assets and actions Codependence is a behavioral pattern in which the patient values himself or herself based on self-assets, actions, and looks rather than what he or she is as a person. The patient exhibits overresponsible behavior and performs activities for others that they could perform on their own. The patient defines self-worth based on his or her care for others even at the cost of neglecting his or her own needs. Codependence refers to a group of behaviors linked to families with alcoholic patients. p. 423

Which statement supports that the patient may be developing a tolerance? (SATA)

-"Over the years it has taken more alcohol to get me drunk." -"I've learned that I may develop a tolerance for my heart medicine." -"Drinking a bottle of wine today doesn't affect me like it did five years ago." -"I need to tell my health care provider that my antidepressant isn't working like it did." People with addictions experience tolerance to the effects of their respective substances. Tolerance is either needing increasing amounts of a substance to receive the desired result or finding that using the same amount over time results in a much-diminished effect. Some prescribed medications might have the same effect, such as some antianxiety medications, analgesics, and beta-blockers. Even antidepressants may result in tolerance. Withdrawal is a set of physiological symptoms that begin to occur as the concentration of the chemical decreases in an individual's bloodstream. It will be specific to the substance ingested, and each substance will have its own characteristic syndrome. p. 409

On examination, the nurse finds that a patient who is a drug addict has nasal damage. Which substance abuse does the nurse suspect?

Cocaine Cocaine is a stimulant and is administered by smoking, injecting, or snorting. Snorting cocaine causes nasal damage. LSD is a hallucinogen that is swallowed or absorbed through tissues in the mouth. Opium is an opioid that is swallowed or smoked. Hashish is a cannabinoid that is smoked or swallowed. p. 410, Table 22.1

Which chemical in tobacco causes addiction?

Nicotine Nicotine is found in tobacco and causes an addictive disorder. This chemical overpowers the reward pathway circuit and releases the neurotransmitter dopamine, which gradually becomes more important than the reward of pleasure. The increased saliency of the addictive process cancels the inhibitory function of the frontal cortex, leading to craving. Cannabinoids are the chemicals found in marijuana. Cocaine and opium are other substances that cause addiction. These are not found in tobacco. pp. 413, 418

A patient has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include

Observation for cardiac dysfunction Cardiac dysfunctions are observed in patients experiencing central nervous system stimulant overdose. p. 418, Box 22.2

Which statement reflects a codependent attitude towards the addiction of a family member? (SATA)

-"I'll handle paying the family bills." -"A good spouse doesn't leave when things get difficult." -"If I had been there, I could have stopped the drinking." Understanding the process of addiction from a family perspective requires careful attention to the family. Codependence is a cluster of behaviors originally identified through research involving the families of alcoholic patients. People who are codependent often exhibit over-responsible behavior: doing for others what others could just as well do for themselves. Symptomatic of codependence is valuing oneself by what one does, what one looks like, and what one has, rather than by who one is. People who are codependent often define their self-worth in terms of caring for others to the exclusion of their own needs. Not relying on a spouse or not wanting children to be affected by addiction expresses dissatisfaction with the situation and recognition of its problems. p. 423

The nurse suspects a patient of substance abuse. What should be the nurse's first intervention?

Assessment for substance use and comorbidities An accurate assessment for substance use and other mental health disorders is the key to successful treatment planning. The nurse needs to determine what substance or substances the patient is using, as well as identify underlying medical and mental health disorders that may affect treatment. A referral is done after the assessment and counseling. Magnetic resonance imaging and a positron emission tomography help in understanding the underlying neurobiology of the brain. They provide better understanding of the mental health disorder and help in detection and treatment. p. 422

How could being part of a family where there is alcoholism and codependency affect nurses in their profession?

Nurses with codependency may see themselves as providers of care, excluding their own needs. The nurses may be at higher risk for relationship difficulties related to codependence if they have grown up in environments where one or more family members were addicted. This may play a role for the nurses to choose this profession because they see themselves as care providers for the patient. This disrupts the objectivity of the treatment process. A codependent person develops an attitude of helping others excluding one's own self and that prevents the person from living a full, satisfying life. Codependency does not help to manage stress. Rather, the individuals may develop maladaptive thoughts or behaviors that may bring on stress in their lives. p. 423

The nurse observes a patient in the intensive care unit (ICU) with insomnia who used to take opioids for chronic pain. After diagnosis, the nurse finds that the patient has enlarged pupils associated with continuous tearing of the eyes. In the report the nurse would document that the patient was showing signs of what?

Opioid withdrawal Screening or diagnosis of substance use disorders includes identification of related symptoms. Symptoms of opioid withdrawal are characterized by difficulty in regular sleep pattern (insomnia), enlarged pupils (mydriasis), and continuous tearing of eyes. These symptoms do not indicate opioid intoxication, stimulant withdrawal, or stimulant intoxication. Opioid intoxication is characterized by bradycardia, feelings of sedation, and pinpoint pupils (meiosis). Stimulant withdrawal is characterized by symptoms ranging from decreased energy and dilated pupils to depression, chest pain, and irregular breathing pattern. Stimulant intoxication is characterized by fatigue, anxiety, and irritability. p. 416, Box 22.1

A patient presents to the clinic seeking help for excessive gambling. What type of addiction is this patient experiencing?

Process Gambling is a process addiction. In process addictions, there are no substances but rather a behavior or the feeling brought about by the relevant action. Behavioral addictions are called process addictions. Compulsion is a behavior, not an addiction. A risky behavior is an action taken that places the person at an increased risk for harm. p. 408

An adult has been abusing amphetamines. As this person withdraws, which assessment finding is most likely?

Psychomotor retardation Withdrawal from amphetamines commonly is associated with symptoms of depression. Psychomotor retardation commonly accompanies depression. Dilation of the pupils, dryness of the oronasal cavity, irregular heart rate, and excessive motor activity are symptoms of amphetamine intoxication. p. 418, Box 22.2

Which type of facility would best support the needs of an impaired patient who is need of long-term help related to hallucinogen abuse?

Residential rehabilitation center A patient with severe impairment as a result of hallucinogen abuse can receive long-term professional medical care in a residential rehabilitation center. Residents of halfway houses reside at the house but continue working outside. These patients may be more vulnerable to relapse. Partial hospitalization provides a combination of psychotherapy and educational groups without having to reside at the hospital but is not the best support for the patient who is severely impaired. An intensive outpatient program is a nonresidential setup that only provides medication oversight, and this would not be the best choice to a patient who is severely impaired. p. 427

What is occurring in the patient with a substance abuse disorder who no longer responds to the effect of the substance?

Tolerance A patient with a substance abuse disorder who no longer responds to the effect of the substance is experiencing tolerance. Withdrawal is a set of physiological symptoms that occur when a person stops using a substance. Addiction is a primary chronic disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway of the brain. Intoxication occurs when a substance is used to excess. p. 409

A patient hospitalized after a heroin overdose shares, "I've been using more heroin lately to get my usual high." The nurse determines that this information supports the existence of what abuse-related outcome?

Tolerance Tolerance is described as needing increasingly greater amounts of a substance to become intoxicated or finding that using the same amount over time results in a much diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. p. 409

A nurse is caring for a patient who has been abusing stimulants. Which symptoms does the nurse look for as a risk for suicide? (SATA)

-Impulsiveness -Social isolation -Loss of occupation Impulsiveness decreases the decision-making abilities and increases the patient's risk for suicide. Social isolation and loss of occupation can make the patient feel depressed and lonely, which increases the patient's risk for suicide. Hallucinations are altered perceptions, which may interfere with clear thinking and increase the patient's risk for injuries. Elevated temperature increases the patient's risk for injuries. p. 424, Table 22.5

A nurse is assessing a patient, who has been withdrawing from cocaine. Which clinical findings of cocaine withdrawal does the nurse observe? (SATA)

-Fatigue -Depression -Poor concentration Poor concentration

A patient describes experiences of having blackouts. The nurse suspects abuse of

Alcohol Chronic abuse of alcohol is associated with blackouts (periods for which the patient has no memory). Abuse of cocaine produces feelings of euphoria. Abuse of mescaline and psilocybin causes alterations in perception. pp. 420-421

Which medication prescribed to a patient for treatment of alcohol addiction may be associated with intense vomiting, respiratory difficulty, and mental confusion?

Disulfiram Disulfiram is used for the maintenance of alcohol abstinence. However, the medication should be taken consistently to maintain the alcohol aversion. Alcohol consumption while on disulfiram leads to a toxic reaction that results in symptoms such as intense nausea, vomiting, respiratory difficulty, and mental confusion. Chlordiazepoxide is used to reduce withdrawal agitation and can cause sedation and seizures. Phenobarbital could result in sedation. Acamprosate calcium causes side effects such as itching, diarrhea, and intestinal gas. p. 425, Table 22.6

The nurse is caring for a woman with chronic alcohol intoxication. The woman is prescribed disulfiram to treat the condition. Which information given by the nurse is appropriate about disulfiram?

You may experience adverse effects if you consume alcohol." Disulfiram is used to treat substance abuse in patients. It is helpful in the period of maintenance. However, the patient should be sure to avoid consuming alcohol during the course of medication. The drug reacts with alcohol to form a toxic reaction, resulting in gastrointestinal and respiratory disorders. Nausea, seizures, and sedation are not observed in the course of medication. Nausea is observed when a patient consumes alcohol during the course of drug therapy. Seizures and sedation are observed during the course of medications like chlordiazepoxide, phenobarbital, and diazepam. p. 425, Table 22.6

A nurse is teaching high school students about commonly abused drugs and their effects. Which common substances are abused through swallowing? (SATA)

-Opium -Alcohol -Marijuana The substances that are abused by swallowing included opium, alcohol, and marijuana. Opium is an opioid that can be swallowed and smoked. Alcohol is found in liquor, beer, and wine and is abused through swallowing. Marijuana is a cannabinoid and can be swallowed and smoked. Nicotine is the main ingredient in tobacco and is smoked, snorted, or chewed. Heroin is an opioid and can be injected, snorted, and smoked. pp. 410-412, Table 22.1

A patient is trying to quit the habit of drinking alcohol. Which symptoms does the nurse recognize as the effect of mild alcohol withdrawal? (SATA)

-Anorexia -Insomnia -Restlessness Mild alcohol withdrawal occurs as the alcohol concentration in the blood slightly reduces. It can lead to anorexia or loss of appetite, insomnia or lack of sleep, and restlessness. Hypersensitivity to noise and light, and grand mal seizures occur in extreme cases of severe alcohol withdrawal as the alcohol concentration in the blood is greatly reduced. p. 420

A nurse interviews a 15-year-old who has engaged in frequent substance abuse. In addition to assessing substance abuse, the nurse should screen for which other problems in this adolescent? (SATA)

-Depression -Eating disorder -Conduct disorder -Antisocial personality The high prevalence of psychiatric comorbidity is supported by statistics from multiple national population surveys. Individuals with mood and anxiety disorders, antisocial behaviors, or histories of conduct or oppositional disorders as adolescents are more than twice as likely to have a substance use disorder. Eating disorders may occur in people abusing stimulants or caffeine. Obsessive-compulsive disorder is not a comorbidity associated with substance abuse. pp. 412, 414, 427

The nurse is assessing an individual for substance abuse disorder. What initial assessments does the nurse do to determine a proper plan of treatment and care? (SATA)

-Pattern of substance use -Assessment of comorbidities -Clinical examination of background -Strength and level of willingness to change The initial assessment involves a clinical examination of the background, including the patient's history, any history of trauma, a family history of substance use or mental health problems, and any disabilities. Knowledge about the pattern of substance use, such as type of substance, frequency, age at initiation, and so forth, helps in properly planning the treatment and care. An individual's strengths and level of willingness to undergo the treatment helps in planning the treatment strategy. Assessment of comorbidities is also done because they may need to be treated simultaneously. A discussion pertaining to a support group takes place in the planning phase, and a support group is involved in the treatment process. It is not a part of the initial assessment. The relapse prevention measures are discussed after the detoxification or rehabilitation is successfully completed. pp. 423, 427

Which are clinical features of fetal alcohol syndrome?

-Short stature -Microcephaly -Craniofacial malformations Clinical features of fetal alcohol syndrome include short stature, microcephaly, and craniofacial malformations. Spina bifida and renal agenesis are not associated with fetal alcohol syndrome. p. 421

The nurse planning educational materials for parents of children with a history of opioid abuse will emphasize which signs when discussing opioid withdrawal? (SATA)

-Sweating -Runny nose -Sleeplessness -Enlarged pupils Signs of opioid withdrawal include dilated pupils, insomnia, diaphoresis, and rhinorrhea. Slurred speech is associated with opioid intoxication. p. 416, Box 22.1

A patient is administered naloxone for an opioid overdose. What withdrawal symptoms does the nurse anticipate? (SATA)

-Yawning -Rhinorrhea -Lacrimation -Piloerection Withdrawal symptoms the nurse can anticipate include rhinorrhea, yawning, lacrimation, and piloerection. Nystagmus occurs in patients experiencing phencyclidine intoxication. p. 415

The nurse is caring for a patient with a substance use disorder. What statement describes the correct way to deal with transference or countertransference for patient care in substance use disorders?

A nurse remains objective throughout the process. The nurse remains cautious about personal thoughts, opinions, and feelings, and remains objective throughout the process. A therapeutic relationship should be established between the nurse and the patient. There is no need of introducing a new nurse in each session. An ongoing evaluation of the process must be conducted to eliminate transference or countertransference. This is done to maintain the objectivity of the treatment process and teach the patient new skills to acquire a healthy lifestyle after recovery. A residential care facility is needed depending on the patient's health-related issues. This has no effect on the nurse-patient relationship. pp. 423-425

A patient is brought to the emergency department for suspected inhalant intoxication and is exhibiting signs of severe agitation and aggression. What plan of care does the nurse anticipate to help stabilize the patient?

Administer haloperidol. The nurse will anticipate administering haloperidol, which can be used carefully to manage severe agitation for patients experiencing inhalation intoxication. Restraints should be used judiciously and only after other interventions have been tried or if the patient tries to harm him- or herself or others. Naloxone is used to treat narcotic overdoses. Severe agitation and aggression can occur as a result of inhalant intoxication and is self-limiting, lasting a few hours to a few weeks. It may not be possible to keep the patient calm. Test-Taking Tip: Look for options that are similar in nature. If all are correct, the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option. p. 415

What is the nurse's most important intervention when caring for a patient experiencing severe alcohol withdrawal symptoms?

Administer prescribed anticonvulsant medication. The patient experiencing severe symptoms of alcohol withdrawal will experience generalized seizures, which are managed by administration of prescribed anticonvulsant medication. It is the most important nursing intervention in patients with severe alcohol withdrawal symptoms. Prescribed hypnotic medications are administered to treat insomnia, which is a mild symptom of alcohol withdrawal. Anorexia is also a mild symptom of alcohol withdrawal and can be managed with suitable appetite stimulants. Patients with severe alcohol withdrawal symptoms may experience a high-grade fever, generally above 101° F. The nurse should administer the prescribed antipyretic to reduce the fever. However, it is not the most important intervention. p. 420

The nurse is attempting to address the patient's inability to motivate him- or herself to stop abusing alcohol. To best facilitate this change in behavior, the nurse

Asks the patient to identify three negative outcomes that chronic alcohol abuse has had on his or her life. Everyone has ambivalence about changing, and there are always advantages and disadvantages to making a change. People are motivated to change when their values and goals conflict with their current behavior and when the benefits of change outweigh the benefits of staying the same. With the patient's permission, interviewing family members would likely be helpful for the purpose of information gathering but has limited potential for stimulating the patient's motivation to change behavior. It is an appropriate intervention to assess the patient's cognitive ability to learn and retain information, but it has limited potential for stimulating the patient's motivation to change behavior. Encouraging the patient to attend AA would be appropriate once the patient is motivated to bring about a change in his or her drinking behavior. p. 426

The nurse is planning care management for a patient with alcohol misuse. What intervention does the nurse plan for rehabilitation of this patient?

Develop motivation and self-help skills. The patient needs assistance with motivation, support, and self-help skills to instill hope and positivity. Repeated counseling, follow-ups, or specialty referrals should be planned as required. Alcohol consumption should be assessed using a brief screening tool. The patient should be clearly advised about the effects of alcohol consumption. p. 425

Prescription of which medication represents part of an aversive therapy approach to treatment of addiction?

Disulfiram When taking disulfiram, an individual who ingests alcohol will experience a toxic reaction that causes intense nausea and vomiting, headache, sweating, flushed skin, respiratory difficulties, and confusion. These symptoms are intended to create an aversion to use of alcohol. Quetiapine fumarate, acamprosate calcium, and naltrexone are medications prescribed to reduce discomfort associated with withdrawal. p. 425, Table 22.6

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested

Gamma-hydroxybutyrate (GHB) The drugs most commonly used to facilitate a sexual assault (rape) are flunitrazepam, a fast-acting benzodiazepine, and GHB and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. LAAM is indicated as a second-line treatment for the treatment and management of opioid dependence if patients fail to respond to drugs like methadone. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Clonidine hydrochloride is a centrally acting α-agonist hypotensive agent. p. 411, Table 22.1

How should the nurse begin a brief intervention for a patient addicted to cigarettes?

Give feedback to the patient about personal risk. The nurse can begin an effective intervention for a patient who is addicted to cigarettes by first providing feedback to the patient about personal risk. This first step helps the patient understand the benefits of smoking cessation. Setting agreeable goals for reducing is a follow up intervention once the patient is ready to begin cessation. The nurse should arrange a follow-up or specialty referral for the patient and provide information regarding tools that may help the patient quit smoking. p. 410, Table 22.1

The nurse is educating a group of adolescents about different kinds of substance abuse. In which category can magic mushrooms be classified?

Hallucinogens Substances may be classified according to their mechanism of action. Magic mushrooms, a common street name of psilocybin, can be classified as hallucinogens for their severe hallucinogenic effects. Stimulants, cannabinoids, and opioids are other categories of substances. Cocaine, amphetamine, and methamphetamine are stimulants. They cause hyperreactivity and provide feelings of exhilaration. Marijuana and hashish are cannabinoids. Heroin and opium are opioids. p. 411, Table 22.1

What symptoms suggest the use of marijuana by a patient?

Increased heart rate and appetite A patient who has been using marijuana will have an increased heart rate and appetite. People who use marijuana often get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from gamma-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD). p. 410, Table 22.1

How does the advanced practice nurse integrate motivational interviewing as a tool in the treatment plan of a patient with a substance use disorder?

It helps the advanced practice nurse assess the stage of change the patient is in and match it with an appropriate treatment process. An advanced practice nurse first understands the change that is occurring in the individual as it relates to the patient's substance use disorder. Then, the nurse assists the patient in correlating the change in the individual with the treatment process. A nurse works as a part of the treatment process rather than introducing an alternative plan. A nurse assists the patient to develop coping skills and motivates the patient to follow the treatment plan. The evaluation of the treatment plan is not a part of counseling. The assessment of substance use disorder and comorbidities is done after the screening and based on that assessment, the counseling starts. p. 425

The nurse assesses a patient who abuses various substances and discovers significant dental problems. The nurse expects that this patient abuses which substance?

Methamphetamines Abuse of methamphetamine is associated with severe dental problems. If opiates are injected, damage to the skin and veins occurs. Alcohol abuse is associated with gastrointestinal erosion as well as other physiologic consequences. Abuse of inhalants is damaging to the respiratory tract. p. 410, Table 22.1

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be a priority outcome for this patient's treatment plan while in the hospital?

Patient will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he or she will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal, such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. It is not likely that the patient will make a total commitment to abstinence within 1 week. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely. p. 423

What should the nurse make a priority for the care of a patient hospitalized with a history of cocaine abuse?

Promoting sleep in the patient Most often, substance abuse results in the neglect of personal needs such as sleep and food. Therefore, the nurse should first aim to promote sleep and safety in the patient. Assisting the patient in setting goals can be done once the patient's condition is stabilized. It instills hope and direction in the patient. The patient is encouraged to perform self-hygiene practices to improve self-esteem. Thereafter, the patient is helped in exploring harmful thoughts and anxieties by developing a therapeutic relationship. pp. 410, 418, 424

When caring for a patient who is intoxicated from alcohol, which need has the highest priority?

Safety and security The plan should address safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and cultural needs. Safety is the highest priority because of the patient's imminent risks for injury while intoxicated. Physiologic stability has the second highest priority. p. 424

The nurse notices withdrawal symptoms in a patient with substance use disorder. What is the priority substance use disorder outcome measure when planning the care of this patient?

Stabilization of the patient The patient needs to be medically stable before addressing nutrition or recovery. Maintenance of proper nutrition is important for patients with substance abuse because their nutrition is often either less or more than their body requires. If the patient is actively using the substance, motivation for treatment is an important outcome measure. Pursuit of recovery lifestyle is a desired outcome measure for the postdischarge period. However, when the patient has withdrawal symptoms, stabilization of the patient is of primary importance. p. 423

The nurse is learning about commonly abused substances and their effects. Which type of drug does the nurse understand to cause increased mental alertness?

Stimulants Stimulants have a stimulating effect that increases energy, heart rate, and mental alertness. Alcohol can cause mild stimulation and relaxation but in higher doses causes impaired memory. Opioids cause impaired coordination, confusion, and drowsiness. Cannabinoids cause relaxation, disturbed balance and coordination, and impaired memory and learning. p. 418,pp. 410-412, Table 22.1

The term tolerance, as it relates to substance abuse, refers to

The need to take larger amounts of a substance to achieve the same effects With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. The use of a substance beyond acceptable societal norms, the additive effects achieved by taking two drugs with similar actions, and the signs and symptoms that occur when an addictive substance is withheld do not correctly describe the term tolerance. p. 409

The nurse cares for a patient with chronic pain. A regular dose of analgesic medication is ineffective in reducing the patient's pain. What does the nurse expect is the cause for the patient's response?

The patient is showing signs of tolerance. The nurse expects that the patient is showing signs of tolerance because the regular dose of an analgesic drug is ineffective in reducing the patient's pain. Tolerance is the phenomenon in which a patient may need increased amounts of a drug to produce the desired effects, or a constant drug dose may cause diminished effects over time. Withdrawal symptoms are seen when the drug concentration in the blood is reduced. Analgesic drugs generally do not cause significant withdrawal symptoms. The excessive usage of a drug results in intoxication. Analgesic drugs do not cause intoxication. Generally, stimulant drugs cause hyperreactivity. Analgesic drugs do not cause hyperreactivity. p. 413

What information is important for the nurse to understand when initiating the use of naltrexone prescribed for alcohol relapse prevention?

The patient needs to be opiate-free for 10 days before starting the medication. It is important that the nurse ensure the patient is opiate-free for 10 days before starting naltrexone for alcohol relapse prevention. Acamprosate calcium tablets are taken three times a day and initiated on the fifth day of abstinence from alcohol. The patient prescribed disulfiram should avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol. p. 425

Why is cognitive-behavioral therapy indicated in a patient with an addiction?

To identify irrational core beliefs in the patient Cognitive-behavioral therapy is conducted for a patient who has an addiction in order to identify irrational core beliefs. Mindfulness and meditation are helpful in sustaining a recovery lifestyle. Motivational interviewing is a technique that helps assess the status of the patient and break denial while enhancing motivation. Cognitive-behavioral therapy aids the patient in exploring thought patterns so that core beliefs can be analyzed. p. 425

The nurse is working with a support team for managing patients with substance use disorders. Why would the nurse consider providing encouragement for self-care as an important step?

To improve self-esteem of the patients Providing support and encouragement helps to improve self-esteem of the patients because most may have neglected themselves. To explore harmful thoughts, developing a therapeutic relationship can help. Current coping skills should be understood and new skills should be identified by the patient to help test the skills in safe settings. To see beyond the current situation and become hopeful, the patient should be assisted in goal setting. p. 424