Substance Use Disorder, Ch.31
Which client statement would indicate alcohol use disorder according to the criteria determined by the DSM-5? (Select all that apply.) A. "I drink too much to be able to keep a job." B. "I started drinking when I was 14 years old." C. "I know I've damaged my liver, but I can't stop drinking." D. "I come from a family of alcohol abusers." E. "I've broken my wrist and an ankle falling when I was drunk."
A. "I drink too much to be able to keep a job." C. "I know I've damaged my liver, but I can't stop drinking." E. "I've broken my wrist and an ankle falling when I was drunk." Criteria is met when there is evidence that continued alcohol use has resulted in the impaired ability to maintain employment as well as physiological damage and injury. The other options are related to potential risk for alcohol abuse.
The daughter of a patient admitted to the intensive-care unit with delirium tremens asks the nurse how long this condition will last. The RN responds: A. "This typically clears in a matter of hours or a few days." B. "This is a progressive disorder. Some get better, while others never recover." C. "Seclusion and restraint will be used to protect her from injury." D. "Her condition will improve once intravenous fluids are started."
A. "This typically clears in a matter of hours or a few days." Delirium is not a progressive disorder, and with effective treatment most individuals show recovery. Neither seclusion nor restraints are the general interventions, since they are excessively restrictive. Although intravenous therapy may be appropriate in terms of resolution of the delirium, this statement does not answer the question.
What type of long-acting medication is most often used for the treatment of alcohol withdrawal? A. Benzodiazepines B. Barbiturates C. Antidepressants D. Anxiolytics
A. Benzodiazepines Long-acting benzodiazepines such as chlordiazepoxide (Librium), diazepam, and lorazepam are useful for treatment of alcohol withdrawal. Some clinicians prefer barbiturates for alcohol withdrawal, but respiratory depression and safety concerns dissuade most prescribers. Antidepressants and anxiolytics may be prescribed to the recovering alcoholic for the treatment of comorbid depression or anxiety.
Twenty-four hours following an admission a patient who experienced a fractured femur in an automobile accident, begins demonstration signs and symptoms that suggest alcohol withdrawal. What assessment data supports this tentative diagnosis? (Select all that apply.) A. Hand tremors that making holding a glass difficult B. Clothing changed due to extreme sweating C. Reports seeing "bugs crawling on the walls" D. Reporting urinary retention E. Experiencing episodes of trachycardia
A. Hand tremors that making holding a glass difficult B. Clothing changed due to extreme sweating C. Reports seeing "bugs crawling on the walls" E. Experiencing episodes of tachycardia Symptoms of alcohol withdrawal include alcoholic tremors, sweating, palpitations, and agitation as well as a hallucination. None of the other options is supported by assessment data.
When initially interviewing an individual experiencing a substance-related disorder, the most therapeutic strategy to establish the nurse-patient relationship would be to ask: A. "How long have you been addicted?" B. "What happens when you use more than is intended?" C. "How has your alcoholism affected your family?" D. "So you use about $500 every week for cocaine?"
B. "What happens when you use more than is intended?" Asking about results is the most therapeutic response, since it is presented with respectful, nonjudgmental use of language, and it avoids using the pejorative terms "alcoholic" or "addict." Asking how long the addiction has lasted is a fact-based inquiry that is directed toward assessing the patient. Asking about family is appropriate but not directly related to the patient's situation; rather, the focus is on others. This may facilitate the potential for projection and/or guilt, or shame. Extent of addiction is a question to pose to the appropriate patient but is not initially therapeutic to ask.
An individual is admitted with withdrawal symptoms. Which symptoms support the belief that the abused substance is an opioid? A. Anxiety, sweating, and irritability B. Dilated pupils, diarrhea, and runny nose C. General fatigue, depression, and paranoia D. Confusion, seizures, and delirium
B. Dilated pupils, diarrhea, and runny nose Opioid withdrawal symptoms include yawning, dilated pupils, gooseflesh, vomiting, diarrhea, runny nose and eyes, sleeplessness, anxiety, irritability, elevated blood pressure and pulse, and a craving for narcotics. Alcohol withdrawal causes anxiety, sweats, tremors, flushed face, irritability, sleeplessness, confusion, seizures, and delirium. Withdrawal from a stimulant would result in general fatigue, apathy, depression, drowsiness, irritability, paranoia, and suicidal ideation.
When an individual is found to have a serum blood alcohol level of 0.17%, which identifying symptom specific to that level of alcohol intoxication would be observed? (Select all that apply.) A. Double vision B. Slurred speech C. Staggering D. Tremors E. Euphoria
B. Slurred speech C. Staggering D. Tremors A serum alcohol level of 0.15% to 0.20% results in decreased motor skills, slurred speech, and tremors. Levels between 0.25 and 0.30 result in double vision, whereas 0.05% to 0.10% results in labile mood, talkativeness, and impaired judgment. Altered equilibrium is observed when the blood alcohol level is over 0.30%, and stupor is observed with levels of 0.40% and higher.
A patient is admitted to the emergency department with shallow respirations, clammy skin, and dilated pupils. The nurse suspects: A. withdrawal from benzodiazepines B. overdose on benzodiazepines. C. withdrawal from cocaine. D. overdose on cocaine.
B. overdose on benzodiazepines. These are expected findings with an overdose of central nervous system depressants like benzodiazepines. In the absence of medical assistance, withdrawal from a benzodiazepine would result in tremors, sweating, seizure risk, anxiety, irritability, hallucinations, and death. Psychological findings are associated with cocaine withdrawal rather than physiologic risk and include anhedonia, craving, irritability, fatigue, mood disorder, and anxiety. The nurse would expect to assess hallucinations, paranoia, insomnia, and hyperactivity with a cocaine overdose.
Which statement made by a patient who has been severely depressed for the past year (with minimal relief using therapy and medications) requires an immediate response from the nurse? A. "I have hope that I will feel better someday." B. "My family is supportive and patient with me." C. "Alcohol helps me feel like I am a real person again." D. "The new medication I just started is promising for me."
C. "Alcohol helps me feel like I am a real person again." This statement creates a concern regarding the use of alcohol to self-treat the feelings of depression and must be followed up. The remaining options are all positive and hopeful regarding specific aspects of the patient's recovery.
When a patient states, "When I stop drinking vodka, I feel even more depressed," the nurse responds: A. "You feel depressed because of the drinking." B. "How long has this been going on?" C. "When did you last stop drinking?" D. "Alcohol is a depressant and increases feelings of depression."
D. "Alcohol is a depressant and increases feelings of depression." This choice is the most responsive to the patient. It gives information in a straightforward manner and takes advantage of a "teachable moment" and psychoeducation. Telling patients why they are depressed is an interpretive statement that tells the patient what is occurring rather than allowing him or her to come to this learning within the work of sobriety. The remaining options are fact-based questions and nonresponsive to the patient's statement.
Which statement best supports the nurse's belief that a patient diagnosed with chronic alcohol abuse is ready to begin a 12-step recovery program? A. "My family will be there to help me every step of the way." B. "I've heard nothing but good things about this type of program." C. "My life is ruined because of alcohol and the way I abuse it." D. "I have no control over my drinking; I need help to stop."
D. "I have no control over my drinking; I need help to stop." Admitting that one is powerless over alcohol and that our lives have become unmanageable because of it is the first step of a 12-step program. While the remaining options show a positive attitude, none of them indicates that the individual recognizes his or her personal inability to control the alcohol use.
