ch 19 addiction
The mental health nurse should focus on preventative efforts including educational interventions related to the abuse of prescription drugs on which client group?
Both genders between the age of 12 and 17
Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which situation
Having several clients complain that their pain medication is not working
A 47-year-old client has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, the client admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?
Imbalanced nutrition: less than body requirements related to chronic alcohol intake
Which drug reverses opioid toxicity?
Naloxone
Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?
benzos
A client who has used IV heroin every day for the past 10 years says, "I don't have a drug problem. I can quit whenever I want." Which defense mechanism is being used by the client?
denial
A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?
elevated temp
A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance? A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class?
hallucinogen PCP is classified as a hallucinogen. Heroin and morphine are considered opioids. Examples of inhalants are aerosols and adhesives. Cannabis is also known as marijuana. MDMA (3-4 methylenedioxymethamphetamine), or Ecstasy or Molly, is a hallucinogen. MDMA, similar in structure to methamphetamine, causes serotonin to be released from neurons in greater amounts than normal. Once released, this serotonin can excessively activate serotonin receptors.
A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6º above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?
risk for injury
A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?
short history of drug use
The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?
tactile hallucinations
Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?
tolerance break
A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states what?
"I should eat small frequent meals if I get nauseated."
A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?
"It can help to prevent you from drinking."
A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?
"What negative consequences have resulted from your drinking?"
The nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?
"Your parent's alcohol use problem is a chronic disease but can be treated."
In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?
12 hours In clients with alcoholism or in chronic drinkers, alcohol withdrawal syndrome usually begins within 12 hours after abrupt discontinuation or an attempt to decrease consumption.
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?
8 Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse?
All the conditions are attributable to the alcohol abuse
While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?
CIWA-Ar
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?
Chlordiazepoxide
A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?
Delirium tremens Delirium tremens may occur 24 to 72 hours after the client's last drink. Elevation of vital signs accompanies restlessness, tremulousness, agitation, and hyperalertness. Tolerance is a need for markedly increased amounts of alcohol to achieve the desired effect. Korsakoff's psychosis is a form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. Wernicke's encephalopathy is an inflammatory hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency.
Which are effects of alcohol withdrawal syndrome? Select all that apply.
Hand tremors Seizures Increased pulse Delirium tremens
The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?
Help them to identify appropriate diversional activities.
When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?
Helping the client identify positive coping mechanisms
Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply.
It is a legal medication, is controlled by a health care provider, and is available in tablet form.
Which medication is used to prevent alcohol withdrawal symptoms?
Lorazepam (Ativan) Safe withdrawal usually is accomplished with the administration of benzodiazepines, such as lorazepam, chlordiazepoxide, or diazepam, to suppress the withdrawal symptoms.
A client is experiencing severe alcohol withdrawal. Which would the nurse most likely assess? Select all that apply.
Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors
A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which action?
Negotiating a conversation with the client about the need to change
A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which about the drug?
Reduces the appeal of alcohol
The nurse is counseling a group of clients recovering from substance abuse about the nature of denial. Which intervention should the nurse teach the clients to use to help them gain insight into their denial?
Teach them to question why they feel threatened.
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?
The client had six drinks a few hours ago.
The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?
The client most likely has a dual diagnosis since she has both a substance dependence and depression.
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?
The drug helps to satisfy the craving for the opioid. Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin.
A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?
The spouse will refrain from the enabling the client's drinking behaviors.
Which statement about clients with a dual diagnosis is accurate?
Traditional methods of treatment have not been very successful for these clients.
An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?
Verbalize feeling safe and comfortable.
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?
Wernicke-Korsakoff syndrome Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy.
Disulfiram has been prescribed for a client receiving treatment for alcoholism. Which should be included in the client's plan of care?
avoid all products containing alcohol
Clonidine is most effective for which symptom of opioid withdrawal?
diarrhea
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?
dopamine The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, producing pleasant feelings or a "high" that is a reinforcing, or positive, experience.
A client has a history of consuming alcohol almost daily while pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol?
fetal alcohol syndrome
A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?
monday morning Symptoms of withdrawal usually begin within 12 hours after cessation or marked reduction of alcohol intake.
A client is brought to the emergency department with a suspected heroin overdose. Which of the following would support this suspicion?
respiratory depression