NURmental health- Substance-Related and Addictive Disorders.

Manifestations of alcohol withdrawal delirium

- Agitation - Anorexia - Anxiety - Delirium - Diaphoresis - Disorientation with fluctuating levels of consciousness - Fever ( temperature 100 F ro 103 F) - hallucinations and delusions - Insomnia - Tachycardia and hypertension.

A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: a) hypotension. b) tension and irritability. c) constipation. d) slow pulse.

- Amphetamines are a nervous system stimulant that are subject to abuse because of their ability to produce wakefulness and euphoria. - An overdose increases tension and irritability. - Amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. - Diarrhea, not constipation, is a common adverse effect

Early signs of alcohol withdrawal

- Anorexia ( NV may occur) - Anxiety, easily startled. - Hyperalertness - Hypertension - Insomnia - Irritability - Jerky movements - Possibly experiences hallucinations, illusions, delusions or vivid nightmares. - Possibly reports a feeling of " shaking inside" - Seizures ( usually appear 7-48 hours after cessation of alcohol) - Tachycardia - Tremors.

Hashish Street names

- Boom, gangster, hash, hash oil, temp.

Pt education under disulfiram therapy

- Ensure agreement to abstain from alcohol and any alcohol containing substances. - Avoid the use of substances that contain alcohol such as cough medicines, rubbing compounds, vinegar, mouthwashes, and aftershave lotions. - Other medications used to assist with cravings include acamprosate calcium ( Campral) and naltrexone ( ReVia)

Club Drugs

- MDMA ( methylenedioxymethamphetamine) ( swallowed, snorted, injected) - Flunitrazepam ( swallowed, snorted) - GHB ( swallowed)

Cannabinoids include

- Marijuana - Hashish smoked and swallowed.

Complications associated with chronic alcohol use

- Vitamin deficiencies + Vitamin B deficiency causing peripheral neuropathies + Thiamine deficiency, causing Korsakoff's syndrome - Alcohol induced persistent amnesic disorder, causing severe memory problems. - Wernicke's encephalopathy, causing confusion ataxia, and abnormal eye movement. - Hepatitis, cirrhosis of liver - Esophagitis and gastritis - Pancreatitis - Anemias - Immune system dysfunctions - Brain damage - Peripheral neuropathy - Cardiac disorders

Intoxication :

- When people are in the process of using a substance to excess, they are experiencing intoxication

Overdose of opioids

- can produce respiratory depression, shock, coma, seizures, and death. - treated with opioid antagonist such as naloxone.

Which drugs may be abused because of tolerance and physiologic dependence. a) Clozapine and amitriptyline hydrochloride b) Alprazolam and phenobarbital c) Verapamil and chlorpromazine d) Lithium and divalproex

Alprazolam and phenobarbital Correct Explanation: Benzodiazepines such as alprazolam and barbiturates such as phenobarbital are addictive, controlled substances. Lithium, diralproex, verapamil, chlorpromazine, clozapine, and amitriptyline aren't addictive substances

A 22-year-old client reports substernal chest pain and states that his/her heart feels like "it's racing out of my chest." The client reports no history of cardiac disorders. The nurse attaches him/her to a cardiac monitor and notes sinus tachycardia with a rate of 136 beats/minute. Breath sounds are clear, and the respiratory rate is 26 breaths/minute. When a cardiorespiratory basis is eliminated, which drug should the nurse question about usage? a) Cocaine b) Barbiturates c) Benzodiazepines d) Opioids

Cocaine Explanation: Because of the client's age and negative medical history, the nurse should question about cocaine use. -Barbiturate overdose may trigger respiratory depression and a slow pulse. -Opioids can cause marked respiratory depression, while benzodiazepines can cause drowsiness and confusion. -Cocaine increases myocardial oxygen consumption and can cause coronary artery spasm, leading to tachycardia, ventricular fibrillation, myocardial ischemia, and MI.

The nurse should suspect that the client taking disulfiram has ingested alcohol when the client exhibits which of the following symptoms? a) Sore throat and muscle aches. b) Fever and muscle soreness. c) Nausea and flushing of the face and neck. d) Bradycardia and vertigo.

Nausea and flushing of the face and neck. Correct Explanation: The client who drinks alcohol while taking disulfiram experiences sweating, flushing of the neck and face, tachycardia, hypotension, a throbbing headache, nausea and vomiting, palpitations, dyspnea, tremor, and weakness

The nurse is assessing a client for heroin addiction. Which of the following indicate the client has used heroin? a) Pupils large and dilated. b) Drooping eyelids. c) Pupils small and constricted. d) Whites red and bloodshot.

Pupils small and constricted. Correct Explanation: - Heroin causes pinpoint pupils. - Marijuana causes the eyes to appear red and bloodshot. - Cocaine use causes pupils to dilate. - Drooping of the eyelids is not typically associated with the use of any substance. (less)

When monitoring a client recently admitted for treatment of cocaine addiction, a nurse notes sudden increases in the arterial blood pressure and heart rate. Which medication should the nurse prepare to administer? a) Norepinephrine b) Nitroglycerin c) Lidocaine d) Nifedipine

Nifedipine Explanation: - This client requires a vasodilator such as nifedipine to treat hypertension. - Lidocaine, an antiarrhythmic, isn't indicated because the client doesn't have an arrhythmia. - Although nitroglycerin may be used to treat coronary vasospasm, it isn't the drug of choice in hypertension. - Norepinephrine is used to treat hypotension, not hypertension.

The substance-related and addictive disorders include

- Alcohol - Caffeine - Cannabis - hallucinogen - Inhalant - Opioid - Sedative, hypnotic, anxiolytic - Stimulant - Tobacco.

Alcohol

- Alcohol - Found in liquor, beer, and wine - swallowed.

Other abused drugs compounds

- Anabolic steroids - Inhalants.

Stimulated include

- Cocaine ( snorted, smoked, injected) - Amphetamine ( swallowed, snorted, smoked, injected) - Methamphetamine (swallowed, snorted, smoked, injected)

Hallucinogens

- LSD - Mescaline - Psilocylin

Alcohol

- Nicotine - Found in cigarettes, cigars, bidis, and smokeless tobacco ( snuff, split, chew, snort) - Health risk: + Increase blood pressure and heart rate + Chronic lung disease, cardiovascular disease, stroke, cancer.

Addiction is

- a primary, chronic disease of brain reward, motivation, memory, and related circuitry. - s/s: loss of behavioral control with craving and ability to abstain, loss of emotional regulation, and loss of ability to identify problematic behaviors and relationships.

Opioids include

- substances such as opium, heroin, meperidine ( Demerol), morphine sulfate, codeine sulfate, methadone ( Dolophine), hydromorphone ( Dilaudid), oxycodone ( OxyContin), hydrocodone ( Lortab), and fentanyl ( Sublimize)

Withdrawal effects of opioids include

- yawning - insomnia - irritability, chills, fever - rhinorrhea - diaphoresis - cramps, muscle aches - NV, diarrhea - lacrimation.

Which food should the nurse eliminate from the diet of a client in alcohol withdrawal? a) regular coffee b) orange juice c) eggs d) milk

regular coffee Correct Explanation: - Regular coffee contains caffeine, which acts as a psychomotor stimulant and leads to feelings of anxiety and agitation. - Serving coffee to the client may add to tremors and wakefulness. - Milk, orange juice, and eggs are part of a well-balanced, high-protein diet needed by the client in alcohol withdrawal, who is nutritionally depleted

Opioids include

- Heroin - Opium. Injected, smoked, and snorted.

Marijuana's commercial and street names

- Blunt, dope, ganja, grass, herb, joint, bud, Mary Jane, pot reefer, green, trees, smoke, weed, sinsimella, skunk, weed.

Dissociative Drugs

- Ketamine - PCP and analogs. - Saliva divinorum - Dextromethorphan ( DXM)

Withdrawal of opioid can be treated with

- methadone detoxification or tapering dosage with other opioids - Clonidine ( Catapres) and alpha adrenergic blocker assists in reducing the severity of SNS generated withdrawal discomfort. - Specific measures for symptoms management: bismuth subsalicylate ( Kaopectate) for diarrhea and acetaminophen ( Tylenol) for muscle aches.

A nurse is caring for a young child who is experiencing verbal tics and motor tics such as eye blinking and protruding their tongue? Based on this assessment, which medication would the nurse consider administering? a) Fluvoxamine b) Haloperidol c) Fluoxetine d) Paroxetine

Haloperidol Correct Explanation: Haloperidol is the drug of choice for treating Tourette syndrome. Fluoxetine, fluvoxamine, and paroxetine are antidepressants and are not used to treat Tourette syndrome

A client who reports consuming 1 qt (1 L) of vodka daily is admitted for alcohol detoxification. The nurse anticipates the need to teach the client about which medication? a) Thiothixene b) Lithium carbonate c) Lorazepam d) Clozapine

Lorazepam Correct Explanation: - The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. - Benzodiazepines are cross-dependent with alcohol and possess antianxiety and anticonvulsant properties. - Both heightened anxiety and seizures are associated with alcohol withdrawal. - Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs are not used to manage alcohol withdrawal syndrome

A client is entering the chemical dependency unit for treatment of alcohol dependency. Which of the client's possessions should the nurse place in a locked area? a) toothpaste b) dental floss c) shaving cream d) antiseptic mouthwash

antiseptic mouthwash Correct Explanation: Antiseptic mouthwash commonly contains alcohol and should be kept in a locked area unless labeling clearly indicates that the product does not contain alcohol. A client with an intense craving for alcohol may drink mouthwash that contains alcohol. Personal care items, such as toothpaste, dental floss, and shaving cream, do not contain alcohol, and the client would be allowed to keep them in the room

Which finding should lead the nurse to suspect that a client is addicted to heroin? a) labile mood b) aggression c) hypoactivity d) hilarity

hypoactivity Correct Explanation: The client who is addicted to heroin is most likely to exhibit hypoactivity. Initially, the client feels euphoric. This is followed by drowsiness, hypoactivity, anorexia, and a decreased sex drive. Hilarity, aggression, and a labile mood usually are not associated with heroin addiction.

Intoxication: opioids

- Constricted pupils - Decreased respirations - Drowsiness - Euphoria - Hypotension - Impairment of memory, attention, and judgment - Psychomotor retardation - Slurred speech.

Disfulfiram ( Antabuse therapy)

- Disulfiram is an alcohol deterrent for alcohol dependence. - Sensitizes the client to alcohol so that a disulfiram-alcohol reaction occurs if alcohol is ingested. - Client must abstain from alcohol for at least 12 hours before the initial dose is administered. - Adverse effects begin within several min to 0.5 hrs after consuming alcohol and may lase 0.5-2 hours. - Client must avoid drinking alcohol for 14 days after disulfiram therapy discontinued; otherwise, the client is at risk for a disulfiram alcohol reaction.

Adverse effects of disulfiram ( Antabuse) therapy

- Facial flushing - Sweating - Throbbing HA - Neck pain - NV, hypotension - Tachycardia - Respiratory distress.

For the client experiencing alcohol withdrawal delirium, which of the following primary care provider orders should the nurse question? a) lorazepam, 2 mg P.O. every 4 hours p.r.n. b) chlorpromazine, 100 mg P.O. every 4 hours p.r.n. c) thiamine, 100 mg I.M. daily for 3 days. d) chlordiazepoxide, 50 mg P.O. every 4 hours p.r.n.

chlorpromazine, 100 mg P.O. every 4 hours p.r.n. Explanation: The nurse should question the order for chlorpromazine, 100 mg P.O. every 4 hours p.r.n., for agitation. Chlorpromazine is a major tranquilizer and antipsychotic that decreases the seizure threshold. During alcohol withdrawal, central nervous system irritability is present, and seizures can occur. The nurse should question this drug order because of the increased risk of seizure. Lorazepam, 2 mg P.O. every 4 hours p.r.n., is an appropriate order because lorazepam is a benzodiazepine used to ease the symptoms of withdrawal from alcohol. Chlordiazepoxide, 50 mg P.O. every 4 hours p.r.n., for agitation is an appropriate order because chlordiazepoxide is a benzodiazepine used to ease the symptoms of withdrawal from alcohol. Thiamine, 100 mg I.M. daily for 3 days, is appropriate and is used to prevent neurologic consequences in the client with chronic alcoholism.

client brought by ambulance to the emergency department after taking an overdose of barbiturates is comatose. The nurse should assess the client for: a) status epilepticus. b) kidney failure. c) cerebrovascular accident. d) respiratory failure.

respiratory failure. Correct Explanation: Because barbiturates are central nervous system depressants, the nurse should be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate overdose. Kidney failure, cerebrovascular accident, and status epilepticus are not associated with barbiturate overdose. (less)

Alcohol withdrawal

- Early signs develop within a few hours after cessation of alcohol intake. - Peak after 24-48 hours and then rapidly disappear, unless the withdrawal progresses to alcohol withdrawal delibrium. - Chlordiazepoxide ( Librium) is a commonly prescribed medication for acute alcohol withdrawal and is usually given orally, unless a more immediate onset is required ( any benzodiazepine would decrease the withdrawal symptoms because of cross tolerance. - IM injection of vitamin B1 ( thiamine) followed by several days of oral administration to prevent Wernicke's encephalopathy. - Provide small, frequent, high carbohydrate foods ( antiemetic before meals as needed)

A client admitted to the alcohol detoxification program asks the nurse if there's anything he can take to "stop me from wanting a drink so badly." The nurse should teach the client about: a) magnesium sulfate. b) naltrexone. c) haloperidol. d) chlordiazepoxide.

naltrexone. Explanation: - Naltrexone is a drug that can decrease alcoholic cravings. - Chlordiazepoxide and other sedatives help reduce the symptoms of alcohol withdrawal but don't decrease cravings. - Haloperidol may be given to treat clients with psychosis, severe agitation, or delirium. - Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

A client is prescribed clonidine to treat alcohol withdrawal. Which finding should the nurse look for following administration of the drug? a) Numbness and tingling b) Hypotension c) Polyuria d) Tremors

Hypotension Explanation: - Clonidine is used as adjunctive therapy in opioid withdrawal. It is mainly used for the treatment of blood pressure, however. - With treatment for alcohol withdrawal, a priority assessment should be for hypotension. - Polyuria, numbness and tingling, and tremors are not common side effects of clonidine

client with a history of polysubstance abuse is admitted to the facility. He complains of nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance a) Alcohol b) Cocaine c) Opioids d) Cannabis

Opioids Explanation: Piloerection, pupillary dilation, and lacrimation are specific to opioid withdrawal. A client with alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannabis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation

Which of the following medications is appropriate to administer, if prescribed, to a client experiencing symptoms of early alcohol withdrawal? a) lorazepam. b) disulfiram. c) temazepam. d) quetiapine.

lorazepam. Explanation: - Antianxiety agents such as lorazepam and chlordiazepoxide are commonly used to ease symptoms during early alcohol withdrawal. - Disulfiram is an alcohol deterrent used to maintain sobriety. - Quetiapine is an atypical antipsychotic used to manage the symptoms of schizophrenia. - Temazepam is a sedative-hypnotic not used for alcohol withdrawal

A 22-year-old client reports substernal chest pain and states that his/her heart feels like "it's racing out of my chest." The client reports no history of cardiac disorders. The nurse attaches him/her to a cardiac monitor and notes sinus tachycardia with a rate of 136 beats/minute. Breath sounds are clear, and the respiratory rate is 26 breaths/minute. When a cardiorespiratory basis is eliminated, which drug should the nurse question about usage? a) Opioids b) Cocaine c) Benzodiazepines d) Barbiturates

Cocaine Explanation: - Because of the client's age and negative medical history, the nurse should question about cocaine use. - Barbiturate overdose may trigger respiratory depression and a slow pulse. - Opioids can cause marked respiratory depression, while benzodiazepines can cause drowsiness and confusion. - Cocaine increases myocardial oxygen consumption and can cause coronary artery spasm, leading to tachycardia, ventricular fibrillation, myocardial ischemia, and MI

A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug? a) Disulfiram creates a nerve block so that the effects of alcohol are not felt. b) Disulfiram improves the alcoholic's ability to drink limited amounts of alcohol. c) Disulfiram decreases the need for alcohol. d) Disulfiram acts to deter alcohol consumption.

Disulfiram acts to deter alcohol consumption. Explanation: - Disulfiram helps curb the impulsiveness of the problem drinker because disulfiram blocks the breakdown of alcohol in the blood, which produces marked discomfort, such as throbbing headache, flushing, and nausea and vomiting. - Disulfiram does not decrease cravings for alcohol. - No substance can improve the alcoholic's ability to drink moderately. - Disulfiram does not block the effects of alcohol, unlike naloxone, which blocks the effects of opioids and can be helpful in the treatment of opioid addicts.

A nurse is caring for a client who is experiencing alcohol withdrawal. Which assessment finding indicates the need for an as-needed dose of chlordiazepoxide? a) Blood pressure of 100/70 mm Hg b) Blood pressure of 140/80 mm Hg c) Heart rate of 50 to 60 beats/minute d) Heart rate of 120 to 140 beats/minute

Heart rate of 120 to 140 beats/minute Correct Explanation: Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. This finding indicates the need for a central nervous system depressant, which may prevent progression of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. The nurse should carefully monitor the client's vital signs throughout the entire alcohol withdrawal process. (less)

Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect: a) alcohol hallucinosis. b) septicemia. c) alcohol withdrawal. d) a postoperative infection.

alcohol withdrawal. Explanation: - The client's vital signs and hallucinations suggest alcohol withdrawal delirium or alcohol withdrawal syndrome. - Although infection and septicemia may arise as postoperative complications, they wouldn't cause this client's signs and symptoms and would typically occur later in the postoperative course . - Alcoholic hallucinosis occurs 24 to 48 hours after heavy alcohol use. This condition is characterized by hallucinations that occur during a state of clear consciousness that don't involve confusion or significant changes in vital signs

A nurse is caring for a client undergoing opiate withdrawal, which causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: a) barbiturates. b) methadone. c) benzodiazepines. d) amphetamines.

methadone. Correct Explanation: - Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as such opiates as cocaine, heroin, and morphine. - Barbiturates, amphetamines, and benzodiazepines are highly addictive and using these drugs would make detoxification treatment necessary

An intoxicated client is admitted to the hospital for alcohol withdrawal. What should the nurse do to help the client become sober? a) Give the client black coffee to drink. b) Walk the client around the unit. c) Provide the client with a quiet room to sleep in. d) Have the client take a cold shower.

Provide the client with a quiet room to sleep in. Explanation: The nurse should provide the client with a quiet room to sleep in. Alcohol is destroyed and oxidized in the body at a slow, steady rate. - The rate of alcohol metabolism is not influenced by drinking black coffee, walking around the unit, or taking a cold shower. - Therefore, it is best to have the client sleep off the effects of the alcohol

After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective in the client does not develop: a) Hypotension. b) Seizures. c) Hypothermia. d) Psychosis.

Seizures. Correct Explanation: - Generalized seizures may occur on the second or third day of withdrawal from barbiturates. - Without treatment, the seizures may be fatal. - Psychosis is a possibility but is not fatal and will not be prevented by the pentobarbital sodium regimen. - Orthostatic hypotension is possible but is unlikely to be fatal; it is also not treatable by the pentobarbital sodium regimen. - Hyperthermia, rather than hypothermia, occurs during withdrawal

The nurse is assessing a client who has been addicted to barbiturates. Which of the following findings warrants additional action related to the barbiturate use? a) Diaphoresis, twitching, and sneezing. b) Drooling, fainting, and illusions. c) Sluggishness, ataxia, and irritability. d) Suspiciousness, tachycardia, and edema

Sluggishness, ataxia, and irritability. Correct Explanation: typical signs and symptoms of baribiturate abuse include sluggishness, difficulty walking, and irritability. Judgement and understanding are impaired, and speech is slurred and confused. The client acts drunk from alcohol but does not have the oder of alcohol on her breath. Although significant; drooling, fainting and illusions are not effects of barbiturate use. Although significant; diaphoresis, twitching and sneezing are not effects of barbiturate use. Although significant; suspiciousness, tachycardia and edema are not effects of barbiturate use

A client is brought to the hospital's emergency department by a friend, who states, "I guess he had some bad junk (heroin) today." The nurse should assess the client further for: a) Increased heart rate, dilated pupils, and fever. b) Eye irritation, tinnitus, and irritation of nasal and oral mucosa. c) Tremulousness, impaired coordination, increased blood pressure, and ruddy complexion. d) Decreased respirations, constricted pupils, and pallor.

Decreased respirations, constricted pupils, and pallor. Explanation: - Common signs of heroin overdose are respiratory depression, pale or cyanotic skin and lips, pinpoint pupils, shock, cardiac arrhythmias, and seizures. Death may occur from respiratory depression and pulmonary edema. - Increased heart rate, dilated pupils, and increased temperature may indicate stimulant abuse. - Tremulousness, impaired coordination, increased blood pressure, and a ruddy complexion may indicate alcohol intoxication. - Eye irritation, double vision, tinnitus, and irritated mucous membranes could indicate inhalant intoxication

A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later he reports having insomnia, shakiness, sweating, and one seizure. The nurse should first ask the client if he: a) has developed tolerance to the clonazepam and needs to increase the dose. b) has been drinking alcohol with the clonazepam. c) has increased his clonazepam without consulting his health care provider (HCP). d) has stopped taking the clonazepam suddenly.

has stopped taking the clonazepam suddenly. Correct Explanation: - The nurse should first confirm that the client has stopped taking the clonazepam because the client is reporting symptoms of benzodiazepine withdrawal from stopping the clonazepam abruptly. - The client would report symptoms of being sedated if he took alcohol with the clonazepam. - Tolerance symptoms would be increased anxiety, not these physical symptoms. - The client symptoms are consistent with clonazepam withdrawal, not excess, so asking about increased use is not relevant

A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl)(43.2 mmol/dL). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in his hands and feet. The nurse realizes that these symptoms probably result from: a) thiamine deficiency. b) triglyceride buildup. c) a below-normal serum potassium level. d) acetate accumulation.

thiamine deficiency. Correct Explanation: - Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake. - Treatment includes reducing alcohol intake, correcting nutritional deficiencies through diet and vitamin supplements, and preventing such residual disabilities as foot and wrist drop. - Acetate accumulation, triglyceride buildup, and a below-normal serum potassium level are unrelated to the client's symptoms.

Before his hospitalization, a client needed increasingly larger doses of barbiturates to achieve the same euphoric effect he initially realized from their use. From this information, the nurse develops a plan of care that takes into account that the client is likely suffering from problem? a) dependence b) tolerance c) addiction d) abuse

tolerance Correct Explanation: Tolerance for a drug occurs when a client requires increasingly larger doses to obtain the desired effect. Therefore, the plan of care would address the client's state of tolerance. The term addiction refers to psychological and physiologic symptoms indicating that an individual cannot control his or her use of psychoactive substances. This term has been replaced with the term dependence. Abuse refers to the excessive use of a substance that differs from societal norms. Drug dependence occurs when the client must take a usual or increasing amount of the drug to prevent the onset of abstinence symptoms, cannot keep drug intake under control, and continues to use even though physical, social, and emotional processes are compromised.

Flumazenil has been ordered for a client who has overdosed on oxazepam. Before administering the medication, the nurse should be prepared for which common adverse effect? a) Seizures b) Shivering c) Chest pain d) Anxiety

Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain

A client who is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg, and pulse is 92 bpm. Which medication should the nurse expect to administer? a) naloxone b) lorazepam c) haloperidol d) benztropine

lorazepam Correct Explanation: - The nurse would most likely administer a benzodiazepine, such as lorazepam, to the client who is experiencing symptoms of alcohol withdrawal. - The benzodiazepine substitutes for the alcohol to suppress withdrawal symptoms. - The client experiences symptoms of withdrawal because of the "rebound phenomenon" when sedation of the central nervous system (CNS) from alcohol begins to decrease. - Haloperidol is an antipsychotic and is not indicated for alcohol withdrawal symptoms. - Benztropine is used to treat extrapyramidal symptoms associated with antipsychotic therapy. - Naloxone is used in opioid overdose to reverse the CNS depression caused by the opioid.

A client recently admitted to the hospital with sharp, substernal chest pain suddenly reports palpitations. The client ultimately admits to using cocaine 1 hour before admission. The nurse should immediately assess the client's: a) anxiety level. b) level of consciousness. c) neurobehavioral functioning. d) pulse rate and character.

pulse rate and character. Explanation: - Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at postsynaptic receptor sites. Consequently, the drug is likely to cause tachyarrhythmias. - Although neurobehavioral deficits are common in neonates born to cocaine users, these deficits are rare in adults. - As craving for the drug increases, a person who's addicted to cocaine typically experiences euphoria followed by depression, not anxiety.

A 15-year-old boy being successfully treated for Tourette's syndrome tells the nurse, "I am not going to take this medication anymore. Anyone who is really my friend will accept me as I am tics, and all!" What is the nurse's best response? a) "You and your family came to the clinic for treatment, so you can terminate it whenever you wish." b) "Let us talk about what brought you into treatment and why you now want to stop taking medication." c) "I think that is a very unwise decision, but you are entitled to do whatever you wish." d) "Will your lack of medication cause more tics and make you less attractive to girls?"

"Let us talk about what brought you into treatment and why you now want to stop taking medication." Correct Explanation: When an adolescent wants to stop treatment with medication, it represents a desire for more control over his/her life as well as a wish to be free of the disorder with which they have been diagnosed. If the caregiver merely acknowledges the client's right to stop treatment or warns of consequences if the client stops medication, he or she abdicates the adult role of health care advisor. Before any action is taken, the nurse should explore the client's reasoning to see if anything in the medication regimen could be changed to make it more palatable for the client. The client also needs to know that if his current objections cannot be overcome, he can return later to restart his medication.

A client is being admitted to the hospital following an inadvertent overdose with oxycodone. He reveals that he has chronic back pain that resulted from an injury on a construction site. He states, "I know I took too much oxycodone at once, but I cannot live with this pain without them. You cannot take them away from me." Which response by the nurse is most appropriate? a) "Once you are tapered off the oxyocodone, you will find that non-addictive pain medicines will be enough to control your pain." b) Your pain will be controlled by tapering doses of oxyocodone with other pain management strategies and medicines. c) The oxyocodone will be stopped tomorrow, but you will have lorazepam to help you with the withdrawal symptoms. d) "You are going to be switched from the oxyocodone to methadone for long-term pain management.

- Your pain will be controlled by tapering doses of oxyocodone with other pain management strategies and medicines. Explanation: - Tapering doses of oxycodone, pain management strategies, and other pain control medicines are found to be the most helpful with opiate addictions resulting from chronic pain. - Nonaddictive (over-the-counter) medicines alone are generally insufficient for chronic pain management. - Methadone is an addictive opioid that involves substituting one addiction with another, so now clients are being detoxed off methadone as well. - Lorazepam may help with anxiety during withdrawal from opiates, but it does not control the other symptoms of opiate withdrawal

After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective in the client does not develop: a) Psychosis. b) Seizures. c) Hypothermia. d) Hypotension.

Seizures. Correct Explanation: Generalized seizures may occur on the second or third day of withdrawal from barbiturates. Without treatment, the seizures may be fatal. Psychosis is a possibility but is not fatal and will not be prevented by the pentobarbital sodium regimen. Orthostatic hypotension is possible but is unlikely to be fatal; it is also not treatable by the pentobarbital sodium regimen. Hyperthermia, rather than hypothermia, occurs during withdrawal. (less)

A client is being admitted to the hospital following an inadvertent overdose with oxycodone. He reveals that he has chronic back pain that resulted from an injury on a construction site. He states, "I know I took too much oxycodone at once, but I cannot live with this pain without them. You cannot take them away from me." Which response by the nurse is most appropriate? a) The oxyocodone will be stopped tomorrow, but you will have lorazepam to help you with the withdrawal symptoms. b) Your pain will be controlled by tapering doses of oxyocodone with other pain management strategies and medicines. c) "Once you are tapered off the oxyocodone, you will find that non-addictive pain medicines will be enough to control your pain." d) "You are going to be switched from the oxyocodone to methadone for long-term pain management.

Your pain will be controlled by tapering doses of oxyocodone with other pain management strategies and medicines. Correct Explanation: Tapering doses of oxycodone, pain management strategies, and other pain control medicines are found to be the most helpful with opiate addictions resulting from chronic pain. Nonaddictive (over-the-counter) medicines alone are generally insufficient for chronic pain management. Methadone is an addictive opioid that involves substituting one addiction with another, so now clients are being detoxed off methadone as well. Lorazepam may help with anxiety during withdrawal from opiates, but it does not control the other symptoms of opiate withdrawal