Substance Abuse (LPN)
The nurse is caring for a pregnant client with a substance use disorder. Which substance type should the nurse expect to be treated with medication therapy? SATA A) Narcotic B) Cocaine C) Nicotine D) Opioid E) Alcohol
*Kind of a shit question since the client is pregnant, and pregnancy is a grey area for so many meds* Answer: A, C, D, E Rationale: Alcohol, nicotine, and narcotics, including opioids, are substances that medication therapy is used to treat abuse. Medication therapy is not beneficial and would not be appropriate for an addiction to cocaine.
A client who is attending a Narcotics ANonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. How should the nurse respond? A) "The most important initial goal is to admit that you have a problem." B) "The most important initial goal is to learn problem-solving skills." C) "the most important initial goal is to take a personal moral inventory." D) "The most important initial goal is to make amends to people you have hurt."
A) "The most important initial goal is to admit that you have a problem." Rationale: The key initial outcome for clients in NA and similar 12-step substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.
The nurse is caring for a client who is diagnosed with a cocaine addiction. For which additional disorder should the nurse assess this client? A) Anxiety B) Diabetes C) Weight gain D) Kidney Stones
A) Anxiety Rationale: Substance use or abuse commonly co-occurs with other mental health disorders, such as anxiety and depression. In fact, approximately 20% of Americans with an anxiety or mood disorder such as depression also have an alcohol or other substance use disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.
*Shit Question alert* During a prenatal visit, a pregnant client admits to using cocaine at least once per day, and that getting cocaine is her highest priority. Which problem should the nurse make a priority for this client? A) Imbalanced Nutrition: Less than Body Requirements related to limited food intake B) Risk for Infection related to drug use C) Activity Intolerance related to decreased tissue oxygenation D) Impaired Gas Exchange related to respiratory effects of substance abuse
A) Imbalanced Nutrition: Less than Body Requirements related to limited food intake Rationale: A person who abuses substances will spend money on drugs rather than food and other basic needs, which will lead to Imbalanced Nutrition: Less than Body Requirements related to limited food intake. Activity Intolerance related to decreased tissue oxygenation does not relate to cocaine use. Clients may have trouble sleeping or getting adequate rest from using cocaine. Risk for Infection related to drug use might be appropriate for cocaine use, but the question does not specify how cocaine is being used. Impaired Gas Exchange related to respiratory effects of substance abuse is inappropriate because it is a risk, not a current problem. (NANDA-I © 2014)
A client requiring a mandatory court-ordered drug testing is seen in the clinic. On which body tissue should the nurse conduct this testing? SATA A) Serum B) Urine C) Saliva D) Hair E) DNA
A, B, C, D Rationale: Mandatory drug tests may be done with a variety of diagnostic procedures, including testing on urine, saliva, serum, and hair. Genetic/DNA testing is unrelated to drug use.
*Shit question alert* The nurse is teaching high school students about substance abuse. Which should the nurse include about the risk factors for becoming addicted to a substance? SATA A) Peer pressure B) Poor social skill development in the child C) Family history of drug abuse D) Family involvement in child's life E) Depression
A, B, C, E Rationale: Poor social skills, peer pressure, family history of substance abuse, and depression are all risk factors for developing a substance abuse problem. Family involvement in a child's life is not a risk factor; however, lack of family involvement is.
The nurse is completing a health history for an adolescent client and determines that the client would benefite from teaching about substance abuse. Which client statements caused the nurse to come to this conclusion? SATA A) "I drink alcohol with my friends on the weekends." B) "I smoke cigarettes on a daily basis." C) "I use my seatbelt every time I ride in a car." D) "I started having sex when I was 13." E) "I get all A's and B's in school."
A, B, D Rationale: Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.
The nurse prepares a teaching tool about substance abuse in older adults. Which info should the nurse include? SATA A) Older women are more likely to use prescription meds B) Depression and alcohol abuse are disorders frequently found in clients who completed suicide C) Substance abuse is more likely to be recognized in older adults D) Individuals can have substance abuse problems at any age E) Alcohol and other substances can make it difficult to diagnose medical problems
A, B, D, E Rationale: Individuals can have substance abuse problems at any age. Older women are more likely to use prescription medicines. Alcohol and other substances can make it difficult to diagnose medical problems. Depression and alcohol abuse are disorders frequently found in clients who completed suicides. Substance abuse is less likely to be recognized in older adults due to insufficient knowledge, lack of research, and hurried office visits.
The nurse is teaching a class about stress reduction techniques in relation to substance abuse. Which should the nurse include in the lesson? SATA A) Meditation B) Progressive muscle relaxation C) Social drinking D) Effective coping skills E) Abdominal breathing techniques
A, B, D, E Rationale: Important teaching regarding substance abuse includes stress reduction. This may include a variety of techniques including imagery, meditation, muscle relaxation, breathing techniques, and effective coping skills. In substance abuse, alcohol should be avoided entirely, even in medications containing alcohol such as cough medicine.
The nurse is assessing a client with a dependency on cocaine. Which cognitive manifestation should the nurse expect to assess in the client? SATA A) Expresses feelings of anxiety B) Appears overly happy despite the hospital admission C) States sleeping all the time D) Pulls at clothes while fidgeting in the chair E) Talks incessantly with rambling thought patterns
A, B, D, E Rationale: Individuals who routinely use cocaine have symptoms of anxiety; demonstrate excessive talking that indicates rambling thought processes, elation, euphoria, and sometimes tactile hallucinations. Insomnia, not excessive sleeping, occurs in those who routinely use cocaine.
The nurse is caring for a client withdrawing from the hallucinogen LSD. Which non-pharmocologic treatment should the nurse anticipate being used? SATA A) Ensuring low stimuli with minimal light, sound and activity B) Speaking slowly and clearly to the client C) Recommending individual therapy D) Conducting group therapy E) Having one person reassure and "talk the client down."
A, B, E Rationale: During withdrawal from LSD, nonpharmacologic treatment includes speaking slowly and clearly to the client; ensuring low stimuli with minimal light, sound, and activity; and having one person reassure and "talk the client down." Individual and group therapy would be beneficial after the withdrawal of the substance.
The nurse in the employee health clinic knows that nurses are at high risk of developing substance abuse problems. Which should the nurse identify as a reason for this risk? SATA A) Easy access to drugs B) Spending time with coworkers outside work C) Pressures in the workplace D) Frequent contact with drugs E) Working 12 hour shifts
A, C, D Rationale: Easy access to drugs, pressures in the workplace, and frequent contact with drugs are reasons why nurses are at high risk of developing substance abuse problems. There is no correlation between nurses being at high risk of substance abuse and working 12-hour shifts or spending time with coworkers outside the workplace environment.
The nruse is caring for a client with a history of substance abuse. Which statement should indicate to the nurse that the client is progressing through an effective course of recovery? SATA A) "I know I will always need to use the tools from the addiction program." B) "I still like hanging with my old friends." C) "I've been back in school for the last two semesters." D) "I haven't used drugs in over 2 years." E) "I don't think I was really addicted; I just went through a bad patch."
A, C, D Rationale: Statements that indicate abstinence, an awareness of addiction issues, and a return to normal functioning are indicative of recovery. Statements that use such ego defenses as denial and minimization are not signs of effective recovery.
A client is being treated for glue inhalation. Which independent intervention should the nurse expect to implement? SATA A) Maintaining an accurate record of fluid intake and output B) Administering an opioid antagonist intravenously C) Maintaining a quiet environment D) Assigning the client to one nurse for therapeutic intervention E) Assessing the client's heart rate, respirations, and BP
A, C, D, E Rationale: Inhalants can displace oxygen and cause tachycardia and respiratory depression. Assess for renal function because chemicals found in many glues can cause chronic renal damage. It is best to have a single nurse who talks to, calms, and reassures the client until the effects of the substance use subside. To calm the client, external stimuli should be reduced, with minimal sound, light, and activity. An opioid antagonist is not effective with the use of inhalants.
A client is hospitalized for a substance abuse disorder. Which intervention should the nurse directly identify to promote safety for this client? SATA A) Discuss coping skills B) Obtain samples for drug analysis C) Set limits to behavior D) Encourage to verbalize fears E) Obtain a drug history
A, D *Note from Mary: I don't understand why setting limits to someone's behavior wouldn't pertain to client safety... but what do I know? Rationale: Discussing coping skills and encouraging the client to verbalize fears are appropriate interventions for promoting healthy coping skills. Obtaining samples for drug analysis, setting limits to behavior, and obtaining a drug history do not pertain to the client's safety.
The nurse is caring for a client who overdosed on LSD. Which intervention should the nurse provide? SATA A) Reduce environmental stimuli B) Administer opioid antagonist as ordered C) Administer renal dialysis as prescribed D) Speak slowly and clearly with the client E) Have on person "talk down the client."
A, D, E Rationale: For LSD overdose, the nurse should reduce the environment stimuli and have one person "talk down the client." Speaking slowly and clearly with the client is also required. Renal dialysis is used for alcohol, barbiturate, or benzodiazepine overdose, and an opioid antagonist is used for heroin, meperidine, morphine, or methadone overdose. For LSD overdose, the nurse can expect a benzodiazepine or chloral hydrate to be used.
A college student is incoherent; her roommates tell the nurse that she recently "took downers with beer." For which health problem should the nurse observe in this client? A) Hallucinations B) Respiratory depression C) Seizure activity D) Signs of withdrawal
B) Respiratory depression Rationale: "Downers" is a common name for central nervous system (CNS) depressants. CNS depressants and alcohol are a lethal combination, because clients who ingest both types of substances are at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.
A client is admitted for the fourth time in 4 years for opioid detoxification. When planning care for this client, the nurse should consider which pathophysiologic aspect of substance abuse because of its impact on care? A) Aging can impact the body's ability to handle detoxification from alcohol and drugs B) The client's withdrawal may be greater this time than during past detoxifications C) The client's dependency might have been greater this time than during past periods of abuse D) Increased difficulty with opioid detoxification is likely the result of an addiction to another substance at the same time.
B) The client's withdrawal may be greater this time than during past detoxifications Rationale: Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the detoxification process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.
The nurse is teaching a client who uses IV drugs about the potential for health problems. Which infectious blood-borne disease should the nurse include in this teaching? SATA A) Tuberculosis B) Hepatitis B C) HIV D) Hepatitis C E) AIDS
B, C, D, E Rationale: Intravenous (IV) drug use increases the exposure and transmission of certain infectious diseases, such as hepatitis B and C, and HIV/AIDS. Tuberculosis is not a bloodborne disease.
The nurse suspects that a coworker has a substance use disorder. Which finding should the nurse use to confirm this suspicion? SATA A) Wears more makeup than other nurses B) Breath smells like mouthwash C) Wears long sleeves despite hot weather D) Frequently asks peers for breath mints E) Face is frequently flushed when indoors
B, C, D, E Rationale: Potential signs of an impaired nurse include facial flushing; frequent use of breath mints, mouthwash, and perfumes; and wearing long sleeves despite hot weather to cover needle tracks on arms. Wearing makeup is not a warning sign of an impaired nurse.
A client is admitted to the ER after overdosing on PCP. Based on this information, which nursing actions are appropriate? SATA A) Obtain materials to assist with lavage B) Initiate an IV C) Initiate seizure precautions D) Induce vomiting E) Administer aluminum chloride
B, C, E Rationale: PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line and seizure precautions, such as padded side rails. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance, and PCP is usually inhaled in some form.
The nurse is preparing a presentation on substance use disorders for a community group. Which risk factor should the nurse include that predisposes the development of a substance use disorder? SATA A) Divorce B) Family history C) Low income D) Loneliness E) Mental illness
B, D, E -Family hx - Loneliness - Mental illness Rationale: Mental illness, loneliness, and family history are risk factors that might predispose a client to develop a substance use disorder. Having a low income or being divorced does not predispose a client to developing a substance use disorder.
After assessing a new client who admits to opioid addiction, a nursing student expresses the belief that drug addiction is not a real illness because "people who use drugs do it to themselves." Which response by the staff nurse is appropriate? A) "Sometimes a client doesn't show much effort to change his or her behavior." B) "We are legally obligated to provide care, regardless of the cause of a client's illness." C) "It is important to remain nonjudgemental when caring for any client, even a drug addict." D) "You're right, I don't know why we bother."
C) "It is important to remain nonjudgemental when caring for any client, even a drug addict." Rationale: Nurses must maintain a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward managing an addiction, the development of a trusting relationship with the nurse helps set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.
The nurse is providing care to a client with alcohol and opioid dependency. The client's mother states, "I don't understand why my daughter has been prescribed naltrexone, because it causes a high too, right?" Which response by the nurse is appropriate? A) "Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs." B) "Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer." C) "Naltrexone helps diminish your daughter's cravings for alcohol and opioids." D) "Naltrexone will prevent your daughter from getting drunk when she drinks."
C) "Naltrexone helps diminish your daughter's cravings for alcohol and opioids." Rationale: Naltrexone helps reduce cravings for alcohol and opioids by blocking the pathways to the brain that trigger a feeling of pleasure when these substances are used. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed. Naltrexone is not used as an alternative to street drugs, nor does it prevent alcohol intoxication.
A nurse is caring for a newborn who is being treated in the NICU due to complications from exposure to illicit drugs in utero. The newborn has microcephaly and multiple cerebral infarcts and is inconsolable with a high-pitched cry. Which drug is likely to blame for the newborn's symptoms? A) Marijuana B) PCP C) Cocaine D) LSD
C) Cocaine Rationale: The newborn is likely showing symptoms of cocaine withdrawal. Although the other substances listed here have all been linked to fetal manifestations, they do not match the specific clinical manifestations this newborn is displaying.
A pregnant client experiences abruptio placentae. The father of the baby asks the nurse why this has happened. Which risk factor in the client's history is the most likely cause for this condition? A) Maternal use of marijuana during pregnancy B) Genetic history C) Maternal use of methadone during pregnancy D) Low maternal and folic acid levels
C) Maternal use of methadone during pregnancy Rationale: Maternal use of methadone during pregnancy puts a woman at risk for abruptio placentae. Methadone use is also associated with fetal distress, meconium aspiration, preterm labor, rapid labor, and severe withdrawal in the newborn. Marijuana use is associated with an increased risk of intrauterine growth restriction (IUGR), but not with an increased rate of placental abruption. Low folic acid levels would contribute to neural tube problems. Genetic history does not affect the risk for abruption.
A nurse who works in the ER is caring for a client who has overdosed on cocaine. The nurse receives an order from the HCP to administer a prescription antipsychotic. Which symptoms of cocaine overdose would this medication help manage? SATA A) Alkaline urine B) Decreased deep tendon reflexes C) Hyperpyrexia D) Respiratory distress E) CNS depression
C, D -Hyperpyrexia -Respiratory distress Rationale: Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help manage the hyperpyrexia, respiratory distress, cardiovascular shock, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.
*Possible exam question* The nurse is providing care to a client during a prenatal visit. The nurse suspects that the client has used cocaine. Which clinical manifestations support the nurse's suspicion? SATA A) Increased appetite B) Pinpoint pupils C) Muscle jerks D) Hypertension E) Bradycardia
C, D -Muscle jerks -HTN Rationale: Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.
The nurse is caring for a client experiencing withdrawal from a CNS depressant. Which collaborative treatment should the nurse expect to implement? SATA A) Recommending group therapy B) Taking vital signs every hour C) Inducing vomiting D) Using activated charcoal to absorb the drug E) Keeping the client awake
C, D, E Rationale: During withdrawal from CNS depressants, treatment includes keeping the client awake, inducing vomiting while employing aspiration precautions, and using activated charcoal to absorb the drug. Vital signs are taken more frequently than hourly and should be monitored every 15 minutes. Group therapy would be beneficial after the withdrawal of the substance.
The nurse is caring for a client with an addiction to cocaine. Which medication should the nurse expect to be prescribed? A) Opioids B) Opioid antagonist C) Antidepressants D) Antipsychotics E) Dopamine agonists
C, E -Antidepressants -Dopamine agonists Rationale: Pharmacologic treatment for cocaine abuse includes antidepressants and dopamine agonists. Opioids and opioid antagonists are pharmacologic treatment measures for opiates.
Which of the following is not an effect of chronic long-term marijuana use? A) Airway constriction and inflammation B) Decreased spermatogenesis in males C) Chronic bronchitis D) Increased prolactin levels in females
D) Increased prolactin levels in females Rationale: Chronic long-term marijuana use can lead to airway constriction and inflammation and increased incidence of acute and chronic bronchitis. Cannabis use also causes decreased spermatogenesis and testosterone levels in males and suppresses follicle-stimulating, luteinizing, and prolactin hormones in females.
A young client is at 28 weeks gestation. The client's prenatal history reveals past drug abuse, and her urine screen indicates that she has recently used heroin. Which potential health problem should the nurse recognize as the greatest risk to the fetus? A) Congenital anomalies B) Abruptio placentae C) Diabetes D) Intrauterine growth restriction
D) Intrauterine growth restriction Rationale: Women who use heroin place their fetus at increased risk for intrauterine growth restriction (IUGR), as well as withdrawal symptoms, convulsions, tremors, irritability, sneezing, vomiting, fever, diarrhea, and abnormal respiratory function. Congenital anomalies are more commonly associated with use of other drugs, including lithium and dextroamphetamine sulfate. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is more commonly seen with use of alcohol, tobacco, and methadone than with use of heroin.
A client with a hx of substance abuse denies using any narcotics. Which expected outcome should the nurse select for this client? SATA A) The client will remain free from injury B) The client will participate in group therapy C) The client will verbalize the negative effects of alcohol on the body D) The client will admit to having a problem with substance abuse E) The client will describe choices made that contributed to substance abuse.
D, E Rationale: The client admitting to a problem with substance abuse and the client describing choices made that contributed to substance abuse are both expected outcomes for a client diagnosed with Denial, Ineffective. These expected outcomes demonstrate the client's willingness and ability to recognize substance abuse as a problem. The client remaining free of injury, the client verbalizing the negative effects of alcohol on the body, and the client participating in group therapy are not expected outcomes for a diagnosis of Denial, Ineffective. (NANDA-I ©2014)
The nurse is planning care for a pregnant client with a substance abuse disorder. Which intervention should the nurse identify to address imbalanced nutrition in this client? SATA A) Assess for signs of infection B) Educate on negative effects of substances of fetal health C) Educate on negative effects of substances on body D) Obtain daily weight E) Monitor meal intake
D, E Rationale: Weighing the client and monitoring meal intake are appropriate interventions for a client with a nutritional deficit. Assessment of signs of infection would be appropriate for a risk for infection. The client has a potential for enhanced knowledge when educated on the effects of substance use on the body and on fetal health, but they are not related to nutrition imbalances.
