Chapter 23

Within _____ an individual quitting or reducing their intake of habitual cocaine use will experience a "crash"-fatigue, depression, nightmares, headache, profuse sweating, muscle cramps, and hunger.

2-4 days is the peak time for withdrawal symptoms from amphetamine. Intense dysphoria can also occur, peaking between 48-72 hours after the last dose of stimulant.

Trade name for ecstasy

3,4-methylene-dioxyamphetamine (MDMA)

Define addiction

A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled

Define intoxication

A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor

Symptoms of acute alcoholic myopathy include (select all that apply): A. Elevations of CPK B. Red-tinged urine C. parasthesias D. Calf swelling

A, B, D. In acute alcoholic myopathy creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aldolase, and aspartate aminotransferase (AST) are elevated. Urine is red-tinged from myoglobin, a product of muscle breakdown. Parasthesias are characteristic of peripheral neuropathy, not myopathy. Calf swelling, as well as swelling of other muscle groups is also a sign.

Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? A. "They claim they'll help me stay sober." B. "I'll dry out in AA, the I can have a social drink now and then." C. "AA is only for people who reach the bottom." D. "If I lose my job, AA will help me find another."

A. "They claim they'll help me stay sober."

Dan, who's been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states the to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is: A. Denial B. Projection C. Displacement D. Rationalization

A. Denial

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he had been a heavy drinker for a number of years. Labs report he has a blood alcohol of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected? A. Several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink

A. Several hours after the last drink Within 4-12 hours of cessation of or reduction in heavy and prolonged drinking (several days or more), the following symptoms may occur: coarse tremor of the hands, tongue or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated BP; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; insomnia

A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? A. The ct abuses amphetamines and anxiolytics B. The Ct abused alcohol and cocaine C. The Ct is psychotic D. The ct abuses narcotics and marijuana

A. The ct abuses amphetamines and anxiolytics

The nurse monitoring a client admitted for withdrawal from a benzodiazepine knows the client may experience: (Select all that apply) A. Vivid dreams and hallucinations B. Rebound hypertension C. Polyuria D. Sweating E. Nausea or vomiting

A. Vivid dreams, D. Sweating, E. Nausea or vomiting. Additional withdrawal symptoms: pulse greater than 100, increased hand tremor, insomnia, illusions, psychomotor agitation, anxiety, or grand mal seizures. Pg. 376

23. A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."

ANS: A Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.

7. A client diagnosed with chronic alcohol use disorder is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.

ANS: A The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

18. A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family, who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

19. A client diagnosed with depression and substance use disorder has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. B. Sedative-hypnotics are expensive and have numerous side effects. C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

ANS: A The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another and are capable of producing physiological and psychological dependence.

5. A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological addiction. B. The individual is experiencing physical addiction. C. The individual is experiencing substance addiction. D. The individual is experiencing social addiction.

ANS: A The nurse should use the term "psychological addiction" to best describe this client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

1. What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

ANS: A The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

21. A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

ANS: A Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.

29. Which of the following nursing statements exemplify important insights that will promote effective intervention with clients diagnosed with substance use disorders? Select all that apply. A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." C. "Drinking is legal, so the diagnosis of substance use disorder is an infringement on client rights." D. "Opiate addicts are typically uneducated, unrefined individuals who will need a lot of education and social skills training." E. "I can fix clients diagnosed with substance use disorders as long as I truly care about them."

ANS: A, B, D The nurse should examine personal bias and preconceived negative attitudes prior to caring for clients diagnosed with substance-abuse disorders. A deficit in this area may affect the nurse's ability to establish therapeutic relationships with these clients. A nurse who adopts the attitude that he or she can "fix" another person may be struggling with codependency issues.

30. A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? Select all that apply. A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia, resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: A, C The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing or that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia by means of neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

12. A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient drug rehabilitation program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."

ANS: B A positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in the 12-step model for treatment is for the client to admit powerlessness over the substance.

27. In assessing a client with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)

ANS: B If large doses of a central nervous system (CNS) depressant (such as Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.

25. Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? A. Darken the room to reduce stimuli in order to prevent seizures. B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system. D. Teach the negative effects of alcohol on the body.

ANS: B Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.

2. A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance use disorder? A. Narcotic pain medication is contraindicated for all clients with active substance-use problems. B. Clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance use disorder. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

ANS: B The nurse should assess the client for substance use disorder because clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessens the client's response to another drug.

17. A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

ANS: B The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

8. A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediately report to the ED physician? A. Antecubital bruising B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

ANS: B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

22. A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

ANS: C Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

28. The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client, using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

ANS: C The CAGE questionnaire is a screening tool used to determine whether the individual has a problem with alcohol. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.

13. A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "I just need to work harder to get him there on time." Which is the appropriate nursing response? A. "Why do you assume responsibility for his behaviors?" B. "Codependency is a typical behavior of spouses of alcoholics." C. "Your husband needs to deal with the consequences of his drinking." D. "Do you understand what the term 'enabler' means?"

ANS: C The appropriate nursing response is to use confrontation with caring. In Stage One (The Survival Stage) of recovery from codependency, the codependent person must begin to let go of the denial that problems exist or that his or her personal capabilities are unlimited.

26. A client diagnosed with alcohol use disorder joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

ANS: C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

11. Upon admission for symptoms of alcohol withdrawal, a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping

ANS: C The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

15. During group therapy, a client diagnosed with alcohol use disorder states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

ANS: C The nurse should interpret that the client is using rationalization to excuse his alcohol use disorder. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

3. On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

ANS: C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.

20. A client with a history of insomnia has been taking chlordiazepoxide (Librium), 15 mg, at night for the past year. The client currently reports that this dose is no longer helping him fall asleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium

ANS: C Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.

6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy

ANS: D A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.

9. Which client statement demonstrates positive progress toward recovery from a substance use disorder? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my cravings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

ANS: D A client who takes responsibility for the consequences of substance use is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process, in which he or she accepts the fact that substance use causes problems.

24. A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug."

ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

10. A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

ANS: D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.

14. Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepam (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

ANS: D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.

4. Which client statement indicates a knowledge deficit related to substance use? A. "Although it's legal, alcohol is one of the most widely abused drugs in our society." B. "Tolerance to heroin develops quickly." C. "Flashbacks from LSD use may reoccur spontaneously." D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

ANS: D The nurse should determine that the client has a knowledge deficit related to substance use when the client compares marijuana to smoking cigarettes and claims it to be harmless. Both of these substances have potentially harmful effects. Cannabis is the second most widely abused drug in the United States.

16. A nurse is interviewing a client in an outpatient drug treatment clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? A. The client will identify one person to turn to for support. B. The client will give up all old drinking buddies. C. The client will be able to verbalize the effects of alcohol on the body. D. The client will correlate life problems with alcohol use.

ANS: D To promote the recovery process the nurse should expect that the client would initially correlate life problems with alcohol use. Acceptance of the problem is the first step of the recovery process.

Characteristics of children with FAS

Abnormal facial features, small head size, smaller than average height, low body weight, poor coordination, hyperactivity, difficulty paying attention, difficulty in school, learning disabilities, speech and language delays, intellectual disability or low IQ, poor reasoning and judgment skills, sleep and sucking patterns as a baby, vision or hearing problems, problems with the heart, kidneys or bones.

List classes of psychoactive substances that are associated with substance use and substance-induced disorders:

Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco

Dan, who's been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states the to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: A. "Maybe your boss is mistaken, Dan." B. "You are here because your drinking was interfering with your work, Dan." C. "Get real, Dan! You're a boozer and you know it!" D. "Why do you think you boss sent you here, Dan?"

B. "You are here because your drinking was interfering with your work, Dan."

What nutritional deficiency is thought to be linked to both peripheral neuropathy and alcoholic myopathy? A. Magnesium B. Thiamine C. Calcium D. Potassium

B. B vitamins, especially thiamine, are strongly suspected to cause both peripheral neuropathy, nerve damage that causes pain, burning, tingling and prickly sensation of the extremeties, and alcoholic myopathy (acute condition: sudden onset of muscle pain, swelling, weakness, reddish tinged urine from myoglobin, and a rapid rise of muscle enzymes in the blood.

Which of the following medications is the physician most likely to order for client experiencing alcohol withdrawal syndrome? A. Holoperidol (Haldol) B. Chlordiazepoxide (Librium) C. Methadone (Dolophine) D. Phenytoin (Dilantin)

B. Chlordiazepoxide (Librium). Rationale: Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) are the most commonly used. Sometimes physicians order anticonvulsants. Also multivitamins and thiamine are commonly administered. Pg. 408

From which of the following symptoms might the nurse identify a chronic cocaine user? A. Clear, constricted pupils B. Red, irritated nostrils C. Muscle aches D. Conjuctival redness

B. Red, irritated nostrils

A client in detox for heroin can expect what symptoms as he goes through withdrawals? A. Nausea, vomiting, and euphoria B. Runny nose, bristling of the arm hairs and yawning C. Pupillary dilation, somnolence, and fever D. Muscle aches, diarrhea, and slurred speech.

B. Runny nose or rhinorrhea, piloerection, and yawning are symptoms of withdrawal. Other symptoms: nausea and vomiting, pupilary dilation, insomnia, fever, muscle aches, diarrhea, dysphoric mood, lacrimation, and sweating. Euphoria, somnolence, and slurred speech are not withdrawal symptoms. pg 383

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal?

B. Tremors, insomnia, and seizures

Describe events associated with phase II of alcoholism:The Early Alcoholic Phase

Blackouts. Drinking is no longer pleasurable but required. Secret drinking begins. Preoccupation with drinking, maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. Individual experiences guilt and is defensive. Excessive use of denial and rationalization is evident.

A student nurse asked how marijuana affects the cardiovascular system. Which response from the preceptor accurately explains the affects? A. "Cannabis does not affect the cardiovascular system." B. "Cannabis induces bradycardia as well as orthostatic hypotension, which decreases cardiac output." C. "Cannabis induces orthostatic hypotension and tachycardia. This increases the demand for oxygen while decreasing its supply." D. "Because of the increase in blood pressure, the work load of the heart increases greatly, putting the user at risk of MI."

C. "Cannabis induces orthostatic hypotension and tachycardia. This increases the demand for oxygen while decreasing its supply." pg. 386

Symptoms of alcohol withdrawal include: A. Euphoria, hyperactivity, and insomnia B. Depression, suicidal ideation, and hypertension C. Diaphoresis, nausea and vomiting, and tremors D. Unsteady gait, nystagmus, and profound disorientation

C. Diaphoresis, nausea and vomiting, and tremors

Which is not a physiological effect of hallucinogenic drugs? A. Elevation in blood sugar B. Loss of appetite C. Pupil constriction D. Chills

C. Pupil constriction is not a physiological effect of hallucinogens. Effects include: N & V, chills, pupil dilation, increased pulse, increased BP, increased temp, mild dizziness, trembling, loss of appetite, insomnia, sweating, a slowing of respirations, and elevation in blood sugar.

Withdrawal symptoms from CNS depressants may begin: A. 4-8 hours after cessation B. 24-72 hours after cessation C. 5-10 days after cessation D. 12-24 hours after cessation

D. 12-24 hours after the last dose. They reach peak intensity between 24-72 hours later and subside within 5-10 days. pg.376

What are characteristics of Phase IV: The Chronic Phase of alcoholism?

Emotional and physical disintegration. Intoxicated more than they are sober. Profound helplessness and self-pity are evident. Impairment in reality testing may result in psychosis. Life threatening physical manifestations may be evident in every part of the body. Abstention results in: hallucinations, tremors, convulsions, severe agitation, and panic. Depression and thoughts of suicide are common.

S/S of alcoholic hepatitis

Enlarged liver and tender liver, nausea and vomiting, lethargy, anorexia, elevated white blood cell count, fever, and jaundice. Ascites and weight loss may be evident in more severe cases.

In treating codependency, there are four stages. Describe stage I: The Survival Stage

First, the codependent person must begin to let go of the denial that problems exist or that their personal capabilities are unlimited. This may be a very painful and emotional period. pg 404

Opioid derivatives:

Heroin, hydromorphone (dilaudid), oxycodone (percodan; OxyContin), hydrocodone (Vicodin)

What condition may follow Wernicke's encephalopathy?

Korsakoff's psychosis: a syndrome of confusion, loss of recent memory, and confabulation (making up stories to compensate for memory loss). It is frequently encountered with pts recovering from Wernicke's encephalopathy.

Naturally derived opioids:

Opium, morphine, coideine.

An individual who grew up in a home where alcohol was consumed regularly is now using alcohol to relieve stress on a day to day basis. What stage of alcoholism is she in?

Phase 1: The prealcoholic phase. pg 369

What stage of alcoholism is an individual in when they are experiencing physiological addiction and are unable to choose whether or not to drink?

Phase III: The Crucial Phase Binge drinking is common. Drinking is the total focus. Anger and aggression are common manifestations. Individual may experience: loss of job, marriage, family, friends, self-respect. Pg. 370

Common complications of cirrhosis of the liver include:

Portal hypertension: elevation of BP through the portal circulation Ascites: Excess serous fluid accumulation in the abd. Esophageal varices: Veins in the esophagus become distended and may rupture hepatic encephalopathy: Liver can't convert ammonia to urea for excretion so it build up and causes impaired mental functioning, apathy, euphoria, depression, sleep disturbance, increasing confusion and eventually death if not treated.

Features of FAS

Skin folds at corner of eye, low nasal bridge, short nose, indistinct groove between nose and upper lip, small head circumference, small eye opening, small midface, thin upper lip

The stage of recovery where the codependent accepts himself, is willing to change, and experiences integrity through awareness, honesty and being in touch with one's spiritual consciousness is:

Stage IV: The Reintegration stage

What is the focus of the the "Core Issues Stage" (III)?

The codependent person must face the fact that they can't manage relationships by force of will. They must recognize that each partner is autonomous. The goal is to be able to detach from all of the struggles that exist in their life because they are trying to control what they cannot.

Define withdrawal

The physiological and mental readjustment that accompanies the discontinuation of an addictive substance

What occurs in the second stage of recovery for codependency?

This is the Reidentification Stage. The individual is able to see their true self through a break in the denial system. Accept label of codependent. Take responsibility for their dysfunctional behaviors. Accept their limitations.

A very serious form of thiamine deficiency in alcoholics can cause:

Wernicke's encephalopathy. S/S: paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. Death will result without replacement of thiamine.

S/S of Cirrhosis of the liver

Widespread destruction of liver cells which are replaced by fibrous tissue. Nausea, vomiting, anorexia, weight loss, abd. pain, jaundice, edema, anemia, and blood coagulation abnormalities.