Chapter 25: Addiction and Substance Related Disorders
A client is brought into the emergency department because he was involved in an automobile accident. His blood alcohol level (BAL) is 0.10 mg%. Based on this finding, the nurse would expect to assess which of the following? A) Difficulty with coordination B) Stupor C) Emotional lability D) Ataxia
A) Difficulty with coordination Feedback: A BAL of 0.10 mg% would be manifested by difficulty driving and coordinating movements. Ataxia and emotional lability would be associated with a BAL of 0.20 mg%. Stupor would be associated with a BAL of 0.30 mg%.
A nurse is obtaining a history from a client who drinks about six cups of coffee and several diet cola drinks per day. The client states, "I just cut down my coffee and soda intake to one per day." Which of the following would the nurse most likely expect to assess? Select all that apply. A) Headache B) Fatigue C) Yawning D)Flushing E) Diuresis
A) Headache B) Fatigue C) Yawning Feedback: The client's decreased intake of caffeine could lead to caffeine withdrawal, manifested by headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, and nausea. Flushing and diuresis would be characteristic of caffeine overdose.
A nurse is working with a client who is addicted to heroin. The nurse engages in harm reduction by educating the client about which of the following? A) Needle exchange programs B) Problem solving C) Healthy coping skills D) Proper use of naltrexone
A) Needle exchange programs Feedback: Harm reduction initiatives range from widely accepted designated driver campaigns to controversial initiatives such as provision of condoms in schools, safe injection rooms, needle exchange programs, and heroin maintenance programs. Problem solving, coping skills, and naltrexone would not be considered harm-reduction interventions.
A nurse is completing the admission of a client who is seeking treatment for alcoholism. He tells the nurse that the last time he had any alcohol to drink was at 10 a.m., before he left for the hospital. The nurse closely monitors the client. Which of the following would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? Select all that apply. A) Slight diaphoresis B) Hand tremors C) Intermittent confusion D) Heart rate of 135 beats/min E) Normal blood pressure
A) Slight diaphoresis B) Hand tremors E) Normal blood pressure Feedback: A person in stage 1 of alcohol withdrawal syndrome exhibits slight diaphoresis, hand tremors, no confusion, elevated heart rate, and normal or slightly elevated blood pressure. A heart rate of 135 beats/min indicates stage 3, or severe alcohol withdrawal syndrome.
A client tells a nurse that he is committed to trying to quit smoking. When educating the client on smoking cessation, which of the following would the nurse include? A) Success usually involves more than one type of intervention. B) Relapse is fairly rare within the first year of quitting. C) Ear acupressure is a highly proven method for quitting. D) The drug varenicline is widely used among patients with psychiatric disorders.
A) Success usually involves more than one type of intervention Feedback: Successful smoking cessation usually requires more than one type of intervention, including social support and education. Recent research has shown that nicotine addiction is extremely powerful and is at least as strong as addictions to other drugs, such as heroin and cocaine; 70% of those who quit relapse within 1 year. Auricular therapy, or ear acupressure, is being studied as a potential adjunctive treatment for nicotine addiction. Varenicline tartrate reduces the craving and rewarding effects of nicotine by preventing nicotine from accessing one of the acetylcholine receptor sites involved with nicotine dependence, but it can cause depression and related psychiatric symptoms in some people. This side effect limits its usefulness for people with psychiatric disorders.
A man 20 years of age arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on his arms. The friend who came with him reports that the client had just "shot up" heroin when he became unconscious. Which medication would the nurse most likely expect to administer? A)Naloxone B) Naltrexone C) Bupropion D) Varenicline
A)Naloxone Feedback: Naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension. Naltrexone is used to treat alcohol dependence. Bupropion and varenicline are used to promote smoking cessation.
A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when he states which of the following? A) "I've admitted to myself and others the wrongdoings I've done." B) "I realize that there is a higher power that can help me." C) "I know now that I am powerless over alcohol." D) "I am making amends to all those that I've harmed." Feedback: Coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.
B) "I realize that there is a higher power that can help me." Feedback: Coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.
11. 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 which of the following? A) "I can have a glass of wine with dinner if I choose." B) "I should eat small frequent meals if I get nauseated." C) "I should take the drug on an empty stomach." D) "I might experience diarrhea with this drug."
B) "I should eat small frequent meals if I get nauseated." Feedback: A client receiving methadone maintenance therapy may experience nausea. Therefore, the client should eat small, frequent meals to treat the nausea and loss of appetite, and should take the drug with food and lie quietly to minimize the nausea. Alcohol should be avoided. Constipation may occur, necessitating the use of a mild laxative.
A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks a nurse, "How will this drug help me?" Which response by the nurse would be most appropriate? A) "It will help to cure your alcoholism." B) "It can help to prevent you from drinking." C) "It makes the withdrawal symptoms less troublesome." D) "It helps to clear the alcohol out of your body."
B) "It can help to prevent you from drinking." Feedback: Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body.
10. A group of nursing students is reviewing information about substances that are abused. The students demonstrate understanding of the information when they identify which of the following as stimulants? Select all that apply. A)Alcohol B) Cocaine C) Heroin D) Nicotine E) Phencyclidine
B) Cocaine D) Nicotine Feedback: Stimulants include cocaine and nicotine. Alcohol is a depressant. Heroin is an opioid derivative that depresses the central nervous system. Phencyclidine is classified as a hallucinogen.
A nurse is preparing an in-service program about substance abuse and its etiology. Which of the following would the nurse most likely include in the presentation when discussing possible etiologies? A) Mixed self-esteem B) Genetic predisposition C) Dysfunctional family D)Peer influence
B) Genetic Feedback: Substance abuse encompasses the body, the mind, and society's influence. Human and animal studies confirm a genetic predisposition for drinking behaviors and self-administering mind-altering drugs, but as yet no precise genetic marker has been established. Temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and family relationships, and peer pressure all contribute to expression of substance abuse—a chronic and progressive disorder. Dysfunctional family and peer influence reflect social etiologies.
A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which of the following? A) Asking the client questions about alcohol use B) Negotiating a conversation with the client to reduce use C) Pointing out the inconsistencies in thoughts, feelings, and actions D) Helping the client change the way he thinks about a situation
B) Negotiating a conversation with the client to reduce use Feedback: Brief intervention involves a negotiated conversation between the nurse and the client that is designed to reduce the substance use. Asking the client questions about substance use refers to screening. Pointing out inconsistencies reflects confrontation. Helping the client change his or her way of thinking reflects a cognitive approach.
A client with a history of substance abuse is a member of a skills training group. Which of the following would the client be involved in to enhance intrapersonal coping skills? Select all that apply. A) Substance refusal skills B) Problem solving C) Anger awareness D) Emergency planning E) Social support networking
B) Problem solving C) Anger awareness D) Emergency planning Feedback: Topics in skills training groups addressing intrapersonal issues include problem solving, awareness and management of anger, and planning for emergencies. Substance refusal skills and social support networking are skills addressing interpersonal issues.
A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which of the following would a nurse expect to find? Select all that apply. A) Euphoria B) Seizures C) Cardiac arrhythmia D) Paranoia E) Insomnia
B) Seizures C) Cardiac arrhythmia Feedback: Manifestations of cocaine overdose include cardiac dysrhythmias or arrest, increased or reduced blood pressure, respiratory depression, chest pain, vomiting, seizures, psychosis, confusion, dyskinesia, dystonia, and coma. Euphoria, paranoia, and insomnia are effects of cocaine.
A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess? A) Rhinorrhea B) Lacrimation C) Dilated pupils D) Dysphoria
C) Dilated pupils Feedback: With moderate opioid withdrawal, pupils are dilated. Rhinorrhea, lacrimation, and dysphoria are noted with mild withdrawal.
A nurse is talking with a client 57 years of age who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5 a.m. and the client has been having difficulty sleeping. The client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that describes how her nursing supervisor came to visit and gave it to her to wear "so she'd remember to get well." The nurse suspects that the client may be experiencing which of the following? A) Wernicke's syndrome B) Delirium tremens C) Korsakoff's amnesic syndrome D) Malignant hyperthermia
C) Korsakoff's amnesic syndrome Feedback: Korsakoff's amnesic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation, (i.e., telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Wernicke's encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. Delirium tremens is an acute withdrawal syndrome characterized by autonomic hyperarousal, disorientation, hallucinations, and tremors. Malignant hyperthermia is characterized by a sharp increase in body temperature leading to muscle breakdown, kidney and cardiovascular failure, and death.
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 of the following about the drug? A) Causes itching if alcohol is consumed B) Produces the euphoria of alcohol C) Reduces the appeal of alcohol D) Improves appetite and nutritional status
C) Reduces the Appeal of Alcohol Feedback: Naltrexone's effect is unknown. Reports from successfully treated clients suggest three kinds of effects: (1) can reduce craving (the urge or desire to drink), (2) can help maintain abstinence, and (3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink.
A nurse is using motivational therapy with a female client suffering from alcoholism. The client, who is unwilling to consider changing her drinking behavior, emphatically states, "I am not an alcoholic; you can't make me stop drinking." Which response by the nurse would be most appropriate? A) "You have to stop drinking and driving. You could kill someone." B) "You're right. You are not an alcoholic." C) "You should consider what you are doing to your marital relationship." D) "You're the only one who can make yourself stop drinking."
D) "You're the only one who can make yourself stop drinking." Feedback: The acronym FRAMES summarizes elements of brief interventions with clients using motivational interviewing. The nurse should emphasize both the client's freedom to choose to change as well as the client's responsibility to change. Telling the client to stop drinking and driving is confrontational and not therapeutic in this situation; telling the client to think about what she is doing to her marriage is inappropriate because the client has yet to acknowledge that she has a problem. Telling the client that she is not an alcoholic only reinforces the client's denial.
An adolescent client tells a nurse that he or she occasionally "sniffs airplane glue." When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include? A) Tremors and central nervous system arousal B) Enhanced normal heart rhythms C) Enhanced attention on focus and memory D) Brain damage and cognitive abnormalities
D) Brain damage and cognitive abnormalities Feedback: Long-term inhalant use is linked to widespread brain damage and cognitive abnormalities that can range from mild impairment to severe dementia. Tremors, central nervous system arousal, and cardiac changes are not associated with long-term inhalant use. Intoxication can lead to cardiac arrest.