Chapter 19 Substance-Related and Addictive Disorders

A nurse directs an unlicensed assistive person (UAP) to offer oral fluids to a client withdrawing from alcohol. The UAP responds, "That client doesn't deserve my help. This problem is the result of weak character and lack of faith." Select the nurse's most appropriate response. "Why are you making such unkind comments about this client?" "Maybe you should pray with the client for relief from this problem." "You do not have to talk to the client; just provide the oral fluids as I have instructed." "Alcoholism is a disease that hurts many people. The client needs our help and compassion."

"Alcoholism is a disease that hurts many people. The client needs our help and compassion." Substance-related disorders often are deemed incorrectly as self-inflicted. The nurse should help the UAP to understand that alcoholism is a disease as the first step to remaining objective and providing compassionate care. Recognizing and dealing with nontherapeutic responses is essential to the provision of care free of bias or countertransference. The nurse has a responsibility to respond to the UAP's comments. The nurse should not engage the UAP in an argument about "unkind comments," suggest that the UAP pray with the client, or suggest that the UAP does not have to talk to the client. p. 296

Which statement made by a client receiving treatment for a substance abuse problem best indicates an understanding of relapse prevention? "I want so much to stop abusing." "My family has helped me so much in staying sober." "I abuse when I'm bored or lonely, but now I know how to keep busy." "A good time always meant being with friends who abused like I did."

"I abuse when I'm bored or lonely, but now I know how to keep busy." The goal of relapse prevention is to help individuals identify their "trigger situations" so that periods of sobriety can be lengthened over time and lapses and relapses are not viewed as total failures. Identifying both the trigger and a plausible strategy makes that option the best one. The remaining options are more associated with the client's feelings about the addiction. p. 314

For which symptoms will the nurse assess in a client experiencing opioid intoxication? Select all that apply. Decreased respiration Increased respiration Decreased blood pressure Increased blood pressure Constricted pupils Decreased body temperature

-Decreased respiration -Decreased blood pressure -Constricted pupils -Decreased body temperature Opioids have a sedating effect that decreases respiration, blood pressure, and body temperature. Clients may also have constricted pupils. Increased respiration and blood pressure are seen in opioid withdrawal due to reduced concentration of opioids in the blood. p. 305

When planning a substance abuse information program for a local university, the nurse will prioritize which screening? Alcohol Inhalants Stimulants Hallucinogens

Alcohol. Alcohol use disorder is the most common substance-use problem in the United States. The prevalence of alcohol use in the United States is about 70% and approximately 12% are heavy drinkers. While the other options identify substances being abused within our population, none are as prevalent as is alcohol abuse. p. 296

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 Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min The data consistent with opiate overdose are 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. 305

Upon examination, the nurse finds that the client who has acknowledged abusing drugs is experiencing nasal damage. Which substance does the nurse suspect is being abused? Lysergic acid diethylamide (LSD) Opium Hashish Cocaine

Cocaine Cocaine is a stimulant and is administered by smoking, injecting, or snorting. Snorting cocaine causes nasal damage. Lysergic acid diethylamide (LSD) is a hallucinogen, which is swallowed or absorbed through tissues in the mouth. Opium is an opioid, which is swallowed or smoked. Hashish is a cannabinoid, which is smoked or swallowed. p. 298

Which statement is true regarding substance addiction and medical comorbidity? Medical comorbidities are uncommon among clients with substance abuse disorders. Little research has been done regarding substance abuse disorders and medical comorbidity. Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Comorbid conditions are thought to positively affect those with substance abuse disorders because clients seek help for symptoms sooner.

Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Conditions such as hepatitis, tuberculosis, and pancreatitis are common comorbidities. Medical comorbidities are common. There is research, such as the 2001-2003 National Comorbidity Survey Replication (NCS-R), showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction by causing added symptoms, stress, and burden. p. 297

Which steps does the nurse include when planning care for clients being treated for alcoholism? Create a plan to deal with relapse. Recognize that recovery is an achievable goal. Assist the individual to learn to limit use of illegal substances. Support the individual to identify reasons for substance abuse. Help the individual replace unhealthy defenses with healthy coping.

Create a plan to deal with relapse. Recognize that recovery is an achievable goal. Help the individual replace unhealthy defenses with healthy coping. To maintain long-term sobriety, each individual must prepare for and anticipate the possibility of relapse. Recognizing that recovery is an achievable goal is part of instilling hope. Addicted persons use denial as an unhealthy defense and need help learning to use healthy coping strategies. Addicted persons must avoid all use of substances. Identifying reasons for substance abuse is part of the unhealthy use of rationalization. p. 319

For which symptoms will the nurse assess in a client experiencing opioid intoxication? Decreased respiration Increased respiration Decreased blood pressure Increased blood pressure Constricted pupils Decreased body temperature

Decreased respiration Decreased blood pressure Constricted pupils Decreased body temperature Opioids have a sedating effect that decreases respiration, blood pressure, and body temperature. Clients may also have constricted pupils. Increased respiration and blood pressure are seen in opioid withdrawal due to reduced concentration of opioids in the blood. p. 305

A nurse interviews a 15-year-old who has engaged in frequent substance abuse. The nurse should screen the client for which possible comorbid problems? Depression Eating disorder Conduct disorder Antisocial personality Obsessive-compulsive disorder

Depression 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. Obsessive-compulsive and eating disorders are not comorbidities associated with substance abuse. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 310

Which observation indicates to the nurse that a client is at risk for codependent behavior? Promising to change his or her irresponsible behavior Lack of empathy and care toward others Family history of tobacco abuse Feeling guilt for a family member's drug use

Feeling guilt for a family member's drug use Codependence involves overresponsible behavior and performing activities for others that they could perform on their own. Codependence is common among friends and family members of individuals with substance-related and addictive disorders. Feeling guilt for someone else's drug us is an example of a codependent behavior. Promising to change one's own behavior, lack of empathy, and family history of tobacco use are not risk factors for codependent behaviors. p. 301

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

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. Marijuana and hashish are cannabinoids. Heroin and opium are opioids. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 308

What symptoms are most suggestive of marijuana use by a client? Increased appetite and anxiety Violent behavior and psychosis Disorientation and memory loss Hallucinations and sweating

Increased appetite and anxiety. A client who has been using marijuana may have an increased appetite and anxiety. People who use marijuana frequently get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from γ-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD). Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. p. 306

How does the counselor integrate motivational interviewing as a tool in the treatment plan of a client with a substance use disorder? It helps the counselor use strategies to resolve ambivalence and evoke internally motivated change. It introduces an alternative treatment process that is parallel to the current treatment process. It modifies the current treatment process by evaluating it frequently and giving inputs related to health care. It assesses the substance-related disorder and determines if other comorbidities are present.

It helps the counselor use strategies to resolve ambivalence and evoke internally motivated change. A counselor first understands the change that is occurring in the individual as it relates to the client's substance use disorder. Then, the counselor assists the client in correlating the change in the individual with the treatment process. A counselor works as a part of the treatment process rather than introducing an alternative plan. A counselor assists the client to develop coping skills and motivates the client 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 counseling is based on that assessment. p. 316

What characteristic should the nurse monitor to best ensure the safety of a client who has a blood alcohol level of 0.08 mg %? Confusion Motor coordination Fever Respiration

Motor coordination The client with a blood alcohol level of 0.08 mg % will have decreased motor coordination. When the blood alcohol level is at 0.30 mg %, the person will have a high level of confusion. Fever may occur during alcohol withdrawal. Respiration may be impaired when blood alcohol level is 0.50 mg %. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 302

Which chemical in tobacco causes addiction? Nicotine Cannabinoids Cocaine Opium

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. p. 305

The nurse, assessing a client reporting fever, diarrhea, and nausea, notes the dilation of the pupils and heightened reflexes. These assessment finding support which medical diagnosis? Opioid withdrawal Opioid intoxication Alcohol withdrawal Stimulant withdrawal

Opioid withdrawal. Opioid withdrawal manifests as a set of physiological symptoms that begin to occur when the concentration of opium decreases in the client's bloodstream. Symptoms include fever, diarrhea, and nausea. These symptoms are not caused by opioid intoxication, alcohol withdrawal, or stimulant withdrawal. Opioid intoxication is characterized by decreased heart rate, blood pressure, body temperature, body reflexes, and pinpoint pupils. Alcohol withdrawal is characterized by restlessness, irritability, impairment in functioning, and trembling. Stimulant withdrawal is characterized by depression, poor concentration, and paranoia. p. 305

A nurse is teaching high school students about commonly abused drugs and their effects. Which common substances are abused via swallowing? Opium Alcohol Marijuana Nicotine Heroin

Opium Alcohol Marijuana Substances that are abused by swallowing include opium, alcohol, and marijuana. Opium is an opioid which 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 (but not swallowed). Heroin is an opioid and can be injected, snorted, and smoked. p. 298

When caring for a client demonstrating signs and symptoms of alcohol intoxication, which need is the priority? Self-esteem Safety and security Cultural preferences Physiological stability

Safety and security. Safety is the highest priority because of the client's imminent risks for injury while intoxicated. Physiological stability has the second highest priority. The plan should also address self esteem and cultural needs, but these are not the highest priority. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings. p. 310

When considering substance abuse, which individual is at the greatest risk for developing functional deficits in the future? The 15-year-old abusing cannabis The 28-year-old with a cocaine habit The 45-year-old with a 10-year history of heroin abuse The 60-year-old who has been dependent on sedatives for 15 years

The 15-year-old abusing cannabis The 15-year-old abusing cannabis is at greatest risk for developing functional deficits. The brain doesn't fully mature until the mid-20s; therefore, substances of abuse can interfere with brain ability to function in the future. Ingestion of drugs during youth and teenage years can also interfere with psychological and social growth, decrease the potential for a productive future, and it terminates the life span of too many children and teenagers. Although cocaine, heroin, and sedative users may experience adverse effects, they are at less of a risk of developing functional deficits because they are older. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 297

A client was in an automobile accident, and although there is the odor of alcohol on the client's breath, the client's speech is clear, and the client is alert and can answer questions. The client's blood alcohol level is determined to be 0.30 mg %. What conclusion can be drawn? The client has a high tolerance to alcohol. The client ate a high-fat meal before drinking. The client has a decreased tolerance to alcohol. The client's blood alcohol level is within legal limits.

The client has a high tolerance to alcohol. The client has a high tolerance to alcohol. A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. This scenario is not suggestive of the client eating a high-fat meal or having decreased tolerance to alcohol. The blood alcohol level is well above the legal limit in most states. p. 302

A client diagnosed with mouth cancer should be assessed for which type of substance abuse? Opium Alcohol Cocaine Tobacco

Tobacco. Addiction to tobacco causes disorders that include 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. 305

The nurse is assessing a client who reports slowly increasing the number of cigarettes consumed per day over the last 5 years. What aspect of tobacco use is the client describing? Addiction Tolerance Withdrawal Intoxication

Tolerance. Tolerance occurs when a person needs increased quantities of a substance to obtain the desired effect, thereby increasing the total intake of a substance. Addiction is caused due to a disturbance in the regulation of the pleasure-seeking pathway of the brain leading to the need for an increased dose of the same substance for relief. Withdrawal occurs when a person experiences physiological symptoms due to a decrease of the substance in the blood stream. Intoxication occurs when a person uses a substance in excess. p. 299