Pharm II Addiction
A middle-aged patient is prescribed varenicline for smoking cessation. What is the prioritynursing action for this patient?
Teaching the patient that nausea and headaches are likely Rationale Nausea is the most common adverse effect of varenicline. Headaches, abnormal dreams, flatulence, and vomiting are likely with this drug. Orthostatic hypotension and hyperthermia are not a concern with this drug. Avoidance of sunlight is not necessary while on this medication. p. 441
A nurse reviews the chart of a patient taking varenicline. Which information will cause the nurse to notify the physician?
The patient is a truck driver. Rationale The physician is notified because the patient is a truck driver. Owing to concerns about unpredictable physical and psychiatric adverse effects, United States authorities have banned the use of varenicline by truck drivers, bus drivers, airplane pilots, and air traffic controllers. Mild nausea is expected, so the physician would not be notified. Varenicline is given with transdermal nicotine. The provider would be notified if there were a history of psychiatric disorders; however, this patient has no history of psychiatric disorders. p. 441
A patient who receives aversion therapy at an alcohol rehabilitation center has a flushed face and vomits copiously. How should the nurse interpret this finding?
The patient obtained alcohol. Rationale A flushed face, nausea, and vomiting are signs of acetaldehyde syndrome, which is caused by disulfiram therapy when the patient combines disulfiram with alcohol. Erosive gastritis is an effect of alcohol, not an effect of aversion therapy. While the flu does cause vomiting, it is highly unlikely the flushed face and vomiting are from an infection since the patient is in a rehabilitation center receiving aversion therapy. Delirium tremens results from severe alcohol withdrawal and causes an increase in vital signs. p. 432
To help prevent liver failure in a patient who drinks alcohol frequently, the nurse will instruct the patient to avoid which drug?
Acetaminophen Rationale The combination of acetaminophen with alcohol poses a risk of potentially fatal liver injury. Accordingly, some authorities recommend that people who drink take no more than 2 gm of acetaminophen a day (ie, half the normal dosage). Antihypertensive drugs reduce blood pressure. Because alcohol raises blood pressure, it tends to counteract the effects of antihypertensive medications, leading to hypertension, not liver failure. Like alcohol, aspirin, ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDs) can injure the gastrointestinal mucosa. The combined effects of alcohol and NSAIDs can result in significant gastric bleeding but not liver failure. p. 428
The healthcare provider has ordered nicotine gum for a patient who is admitted to the inpatient facility and withdrawing from nicotine. The order reads, "Nicotine chewable gum 2 mg PO every hour PRN not to exceed 30 pieces per 24-hour period." If the patient requests and receives one piece of nicotine gum every 3 hours, how many milligrams of nicotine will the patient receive in 24 hours?
16 mg Rationale If a patient gets a 2-mg piece of nicotine gum every 3 hours, he or she would get 8 doses within 24 hours; 8 multiplied by 2 mg equals 16 mg of nicotine in 24 hours. p. 439
A nurse is teaching the patient who is detoxing from opioid abuse about the drug that will be administered. Which statement by the patient indicates a correct understanding of the teaching?
"I will be taking methadone." Rationale Methadone, a long-acting oral opioid, is the agent most commonly employed for easing opioid withdrawal. Flumazenil is given for benzodiazepine overdose. Diazepam helps reduce anxiety and suppress seizures during cocaine toxicity. Disulfiram can be combined with cognitive behavioral therapy to reduce cocaine use.Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. p. 446
A nurse discusses the side effects of alcohol with a patient. Which patient statement indicates an understanding of the nurse's teaching?
"I will urinate more frequently." Rationale Alcohol is a diuretic. It promotes urine formation by inhibiting the release of antidiuretic hormone from the pituitary. Like all other central nervous system depressants, alcohol depresses respirations. Alcohol suppresses gluconeogenesis, blunts the postprandial rise in blood glucose, and lowers fasting levels of both glucose and insulin. Approximately 35% of cases of acute pancreatitis can be attributed to alcohol, making alcohol the second most common cause of the disorder. Alcohol-induced liver damage can progress from fatty liver to hepatitis to cirrhosis, depending on the amount consumed. p. 426
The nurse is explaining nicotine tolerance to the nursing student. Which statement by the student indicates that the teaching has been effective?
"Smokers develop tolerance to nausea and dizziness." Rationale Users develop tolerance to some effects of nicotine but not to others. Tolerance does develop to nausea and dizziness, which are common in the unseasoned smoker. In contrast, very little tolerance develops to the cardiovascular effects. Veteran smokers continue to experience increased blood pressure and increased cardiac work whenever they smoke. p. 436
The teaching plan for a patient taking bupropion SR should include which statement?
"Take a second dose as early in the day as possible." Rationale Adverse effects of bupropion SR are generally mild and include dry mouth, insomnia, seizure risk, appetite reduction, and weight loss. Bupropion SR should not be taken with monoamine oxidase inhibitors. To minimize sleep interference, the second dose should be taken as early in the day as possible but at least 8 hours after the morning dose. p. 440
A patient is taking disulfiram and wants to know what will occur if alcohol is consumed while taking this drug. What is the nurse's best response?
"You will experience nausea, weakness, and blurred vision." Rationale Disulfiram is used as aversion therapy in the treatment of alcoholism. The use of alcohol with disulfiram can result in nausea, copious vomiting, weakness, blurred vision, and hypotension. In fact, the patient may experience profound hypotension. This reaction, which may last anywhere from 30 minutes to several hours, may be brought on by the consumption of as little as 7 mL of alcohol. Lethargy is not a manifestation of the acetaldehyde syndrome. Severe lower back, leg, and abdominal pain are not symptoms of reaction with disulfiram. Increased blood pressure and hyperactivity are also not typical symptoms of reaction with disulfiram. p. 432
A patient with symptoms of nicotine withdrawal has been prescribed 21 mg of nicotine patch to be taken every 24 hours. How long will the nurse instruct the patient to take this dose?
4 to 6 weeks Rationale The nicotine patch is used to treat symptoms of nicotine withdrawal. For effective treatment, 21 mg of the nicotine patch can be administered for 4 to 6 weeks once per day. After the first 4-6 weeks, the dosage will be reduced; the total duration of use for the nicotine patch will be 8-10 weeks, but the dosage will not remain 21 mg every 24 hours for the entire 8-10 weeks. Nicotine is not typically given for 1 to 3 weeks or 12 to 14 weeks. p. 439
A patient with alcohol withdrawal is given carbamazepine. Which finding indicates a therapeutic effect?
Absence of seizures Rationale Carbamazepine is an antiepileptic and is used to decrease withdrawal symptoms and prevent seizures. Atenolol and propranolol can help decrease cravings during withdrawal. Carbamezepine does not affect respiratory depression or damage to the myocardium; cessation of alcohol will help these effects. p. 431
A nurse gives the patient with alcoholism a drug that will ease unpleasant feelings brought on by abstinence from alcohol. Which drug is the nurse administering?
Acamprosate Rationale Acamprosate reduces some of the unpleasant feelings (eg, tension, dysphoria, and anxiety) brought on by alcohol abstinence following detoxification. Naltrexone is a pure opioid antagonist that reduces the craving for alcohol and blocks its pleasurable effects. Disulfiram is used to prevent alcohol consumption by making drinking unpleasant, even deadly. Chlordiazepoxide is used to facilitate alcohol withdrawal. p. 432
Which of the following statements about acamprosate are true? Select all that apply.
Acamprosate reduces the unpleasant feeling brought on by abstinence. camprosate should not be used in patients with severe renal impairment. Acamprosate has been shown to be more effective than a placebo. Rationale Acamprosate works by reducing unpleasant feelings (eg, tension, dysphoria, and anxiety) brought on by abstinence. This effect contrasts with the effects of disulfiram (which makes drinking unpleasant) and naltrexone (which blocks the pleasant feelings that alcohol can cause). Compared with patients taking a placebo, those taking acamprosate abstained from their first drink longer, had greater rates of complete abstinence, and were abstinent for more total days. If the patient has severe renal impairment, acamprosate should not be used. p. 432
Cannabinoids are approved for which therapeutic uses in the United States? Select all that apply.
Appetite stimulation Suppression of emesis Relief of neuropathic pain Rationale Cannabinoids are approved for therapeutic use in the suppression of emesis, appetite stimulation, and relief of neuropathic pain. In the United States, cannabinoids are not currently approved for use in glaucoma or multiple sclerosis.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past. p. 452
A patient is preparing to start nicotine replacement therapy with nicotine chewing gum. Which instruction should the nurse provide to the patient?
Chew 15 minutes after drinking Rationale Since foods and beverages can reduce nicotine absorption, patients should not eat or drink while chewing or for 15 minutes before chewing. Patients should be advised to chew the gum slowly and intermittently for about 30 minutes. Rapid chewing can release too much nicotine at one time. The average adult dosage is 9 to 12 pieces a day. p. 439
The nurse anticipates that which medication is likely to be prescribed to reduce the symptoms of alcohol withdrawal?
Chlordiazepoxide Rationale Benzodiazepines, such as chlordiazepoxide, are the most effective agents for reducing alcohol withdrawal symptoms. They are safe and can stabilize vital signs, reduce symptom intensity, and reduce the risk of seizures. Carbamazepine also may be used in alcohol withdrawal to reduce the risk of seizures. Morphine is an opioid with a high abuse potential and is not likely to be used during alcohol withdrawal. Disulfiram causes unpleasant effects if alcohol is ingested and may be used to maintain alcohol withdrawal. p. 431
The nurse is caring for a patient who has smoked marijuana for a long time. Which complication, as a result of adverse effects of marijuana, does the nurse expect in the patient?
Chronic respiratory disorders Rationale Chronic marijuana smoke is closely associated with development of bronchitis, sinusitis, and asthma. Lung cancer is another possible outcome. Marijuana has no adverse effect on the liver or kidneys, so it does not result in chronic renal or liver disorders. Smoking marijuana increases the heart rate and produces orthostatic hypotension, but it does not lead to chronic heart disorders. p. 451
A patient has quit smoking. Which symptoms will the nurse assess if the patient experiences abstinence syndrome? Select all that apply.
Cravings Irritability Nervousness Rationale Individuals who discontinue smoking will experience an abstinence syndrome. Prominent symptoms are cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, and weight gain. p. 442
A patient is admitted following a suspected heroin overdose. This condition is most often manifested by which symptoms? Select all that apply.
Decreased respiratory rate Decreased level of consciousness Rationale Overdose of heroin and other opioids is characterized by the classic triad of symptoms that include respiratory depression, coma, and pinpoint pupils. Hypertension, dilated pupils, restlessness, and agitation are not associated with heroin overdose. p. 445
Which assessment findings indicate to the nurse that the patient is using marijuana in high doses? Select all that apply.
Delusions Paranoia Hallucinations Rationale In high doses, marijuana can have serious adverse psychologic effects. The user may experience hallucinations, delusions, and paranoia. Euphoria occurs with low doses. Tachycardia develops when using marijuana in high doses, not bradycardia. p. 451
A nurse is caring for patients who are experiencing abstinence syndrome from barbiturates. For which drug withdrawal syndrome will the nurse monitor in these patients?
Depressant withdrawal Rationale Barbiturates are a classification of depressants. Opioids include heroin, morphine, meperidine, and oxycodone. Inhalants include anesthetics, volatile nitrites, and organic solvents. Psychostimulants include cocaine and methamphetamine.Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) a sound understanding of the subject, (2) the ability to follow explicitly the directions given at the beginning of the test, (3) the ability to comprehend what is read, (4) the patience to read each question and set of options carefully before deciding how to answer the question, (5) the ability to use the computer correctly to record answers, (6) the determination to do well, and (7) a degree of confidence. p. 447
The nurse should recognize which acute effects of alcohol on the brain?
Depression of the central nervous system and activation of the reward center Rationale Alcohol interacts with receptors for gamma-aminobutyric acid and serotonin to promote the release of dopamine. This causes depression of the central nervous system and activation of the reward center.Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. p. 424
Which of the following statements about disulfiram are true? Select all that apply.
Disulfiram has no applications outside the treatment of alcoholism. Acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol. In the absence of alcohol, disulfiram rarely causes significant effects. Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol. Rationale Disulfiram helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested. Disulfiram has no applications outside the treatment of alcoholism. This reaction, which may last from 30 minutes to several hours, can be brought on by consuming as little as 7 mL of alcohol. In the absence of alcohol, disulfiram rarely causes significant effects. Patients should be made aware that the effects of disulfiram will persist for about 2 weeks after the last dose, and thus continued abstinence is necessary. Naltrexone reduces the high from drinking alcohol. pp. 431-432
The college nurse provides a program on drug abuse to students with diverse majors. Which profession will the nurse identify as most likely to abuse opioid drugs?
Health professionals, such as physicians, nurses, and pharmacists Rationale Physicians, nurses, and pharmacists abuse opioids to a greater extent than other similarly educated groups due to ease of access. Science, music, and mathematics professionals are not the most likely to abuse opioids. p. 444
A patient admitted with chest pain has a long-standing history of alcohol abuse. The nurse recognizes the need to monitor the patient for which adverse effects of chronic alcohol use? Select all that apply.
Hypertension Anxiety Tremors Rationale Symptoms of alcohol withdrawal include increased blood pressure, increased pulse, increased temperature, tremors, disturbed sleep, and anxiety. p. 425
Which statement about synthetic marijuana is true?
It does not show up in drug tests Rationale Synthetic marijuana was initially popular because it does not show up in drug tests. It is not a safe alternative to marijuana and has resulted in several deaths. It has no approved medical uses. It is composed of many herbs, any of which can be dangerous. p. 452
A patient experienced a K-hole state. For which drug use will the nurse monitor in this patient?
Ketamine Rationale Some ketamine users experience a state known as the K-hole, likened to a near-death experience in which there is a sense of rising above one's body. LSD, morphine, and phenobarbital do not produce K-hole states. p. 455
A nurse is teaching about psychedelics. Which information should the nurse include in the teaching session?
LSD is the most potent psychedelic. Rationale LSD is the most potent of the psychedelics. Mescaline is 4000 times less potent than LSD. Whereas the effects of LSD are prolonged (responses may last 12 or more hours), the effects of mescaline are shorter: responses to mescaline usually fade within 8 to 12 hours. p. 453
An adolescent's parents report to the nurse that the adolescent, who was bright and motivated a year ago, has become apathetic and disinterested in school and hygiene. Which drug abuse does the nurse suspect in the adolescent?
Marijuana Rationale Chronic, excessive use of marijuana is associated with a behavioral phenomenon known as an amotivational syndrome, characterized by apathy, dullness, poor grooming, reduced interest in achievement, and disinterest in the pursuit of conventional goals. Salvia induces a dream-like state of unreality, not amotivation. Naltrexone is an opioid antagonist used to discourage renewed opioid abuse. Methamphetamine is a stimulant that increases alertness and reduces fatigue; it does not produce apathy and amotivation.Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question.
A nurse is caring for patients who abuse drugs. For which most commonly used illicit drug will the nurse assess when taking histories from these patients?
Marijuana Rationale Marijuana is the most commonly used illicit drug in the United States. Methamphetamine and cocaine use have declined. While MDMA is on the rise, it is not the most commonly used illicit drug.Test-Taking Tip: Track questions that you answer with an educated guess or for which you changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Your first answer usually is correct and should not be changed without reason. p. 450
The nurse encourages a patient with cardiovascular disease to quit smoking. The nurse makes this decision based on which cardiovascular effects of nicotine? Select all that apply.
Nicotine accelerates the heart. Nicotine increases force of ventricular contraction. Rationale The cardiovascular effects of nicotine result primarily from activating nicotinic receptors in sympathetic ganglia and the adrenal medulla. Activation of these receptors promotes release of norepinephrine from the sympathetic nerves and release of epinephrine (and some norepinephrine) from the adrenals. Norepinephrine and epinephrine act on the cardiovascular system to constrict blood vessels, accelerate the heart, and increase the force of ventricular contraction. The net result is elevation of blood pressure and increased cardiac work. Very little tolerance develops to the cardiovascular effects. p. 436
Which of the following statements about nicotine are correct? Select all that apply.
Nicotine improves cognition. Nicotine reduces aggression. Nicotine suppresses appetite. Rationale Nicotine is a central nervous system stimulant. The drug stimulates respiration and produces an arousal pattern on an electroencephalograph (EEG). Moderate doses can cause tremors, and high doses can cause convulsions. Nicotine has multiple psychologic effects. The drug increases alertness, facilitates memory, improves cognition, reduces aggression, and suppresses appetite. p. 435
A patient who is a chronic smoker is being treated at a rehabilitation center. What will the nurse expect to administer to immediately stop cigarette craving in the patient?
Nicotine nasal spray Rationale With the nasal spray, blood levels of nicotine rise rapidly, much as they do with smoking, providing quick relief from withdrawal or from cigarette craving. With the gum, lozenges, patches, and inhaler, blood levels of nicotine rise slowly and remain relatively steady. p. 440
Upon reading the history, a nurse discovers the patient crushed this controlled-release tablet and then snorted the powder. Which drug does the nurse suspect the patient is abusing?
Oxycodone Rationale The controlled release tablets of oxycodone were designed to provide steady levels of oxycodone over an extended time and are safe and effective when swallowed intact. However, abusers do not ingest the tablets whole. Rather, they crush the tablets and then either snort the powder or dissolve it in water and inject the liquid intravenously. Heroin, morphine, and meperidine are not abused in this manner. p. 444
A nurse is reviewing the chart of a patient taking bupropion SR. Which information will cause the nurse to intervene?
Phenelzine Rationale Bupropion SR should not be given to patients taking monoamine oxidase inhibitors such as phenelzine. Combining a nicotine patch with bupropion SR is somewhat more effective than either treatment alone. Bupropion will cause weight loss because it suppresses appetite. A history of appendectomy does not affect treatment with bupropion SR. p. 440
The healthcare provider has ordered a 15 mg nicotine patch to be applied every day for 16 hours and then removed for 8 hours. The patch was applied by the previous nurse at 10:00 a.m. The nurse anticipates the patch should be removed at what time?
Rationale Add 16 hours to 10:00 a.m. to equal 2 a.m. the next day. This is the correct removal time. p. 439
Which action will the nurse take when administering disulfiram?
Remove aftershave lotions/colognes from the room. Rationale Inform patients about the potential hazards of treatment and warn them to avoid all forms of alcohol, including alcohol in vinegar, sauces, and cough syrups, in addition to the alcohol applied to the skin in aftershave lotions, colognes, and liniments. The medication comes only in oral form. Inform patients that tablets may be crushed or mixed with liquid. Instruct the patient not to administer the first dose until at least 12 hours after his or her last drink. p. 432
A nurse caring for a patient with a blood alcohol level of 0.45% monitors the patient closely for which priority assessment?
Respiratory depression Rationale Excessive alcohol intake produces dose-dependent increases in blood pressure and respiratory depression. In general, alcohol acts as a diuretic and causes dilation of cutaneous blood vessels, which produces a feeling of warmth. Maintaining a patent airway and monitoring for respiratory depression are priority assessments after excessive alcohol intake (at or above 0.45% blood alcohol level). p. 425
A patient with alcoholism is prescribed a barbiturate. The nurse has advised the patient to stop drinking alcohol. Which risk is the nurse trying to prevent by giving this advice?
Respiratory depression Rationale The central nervous system (CNS) effects of alcohol are additive with those of other CNS depressants (eg, barbiturates, benzodiazepines, and opioids). Consumption of alcohol with other CNS depressants intensifies the psychologic and physiologic manifestations of CNS depression and greatly increases the risk of death from respiratory depression. Delirium tremens is a severe form of alcohol withdrawal. Korsakoff's psychosis is a neuropsychiatric syndrome common in alcoholics and is caused by thiamine deficiency. Injection of alcohol is used to relieve pain from trigeminal neuralgia. p. 428
The nurse is providing patient teaching about nicotine replacement therapy. The nurse knows the patient needs further teaching about available nicotine delivery systems if the patient says he wishes to take his nicotine in which form?
Subcutaneous injection Rationale The U.S. Food and Drug Administration (FDA) has approved five delivery systems for nicotine replacement therapy: chewing gum, lozenges, a transdermal patch, a nasal spray, and an inhaler. Subcutaneous injections are not available for nicotine replacement therapy. p. 438
Which statements about opioid tolerance are true? Select all that apply.
Tolerance develops to euphoria. Little or no tolerance develops to miosis. Cross-tolerance develops between different opioids. Rationale With prolonged opioid use, tolerance develops to some pharmacologic effects, but not others. Tolerance does develop to the effects of euphoria, respiratory depression, and nausea. In contrast, little or no tolerance develops to constipation and miosis. Because tolerance to respiratory depression develops in parallel with tolerance to euphoria, respiratory depression does not increase as higher doses are taken to produce desired subjective effects. Persons tolerant to one opioid are cross-tolerant to other opioids. However, there is no cross-tolerance between opioids and general central nervous system depressants (eg, barbiturates, benzodiazepines, alcohol).STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. p. 449
Which statements about barbiturate tolerance are true? Select all that apply.
Very little tolerance develops to respiratory depression. Progressively larger doses are needed for the same effect. Cross-tolerance develops to other central nervous system depressants. Rationale Tolerance to subjective effects is significant. As a result, progressively larger doses are needed to produce desired psychologic responses. Unfortunately, very little tolerance develops to respiratory depression. Individuals tolerant to barbiturates show cross-tolerance with other central nervous system depressants. However, little or no cross-tolerance develops to opioids.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past. p. 447
The nurse prepares a teaching session about cigarette smoking. What will the nurse include when discussing signs and symptoms of nicotine use? Select all that apply.
Weight loss Elevated mood Increased alertness Rationale Nicotine increases alertness, facilitates memory, improves cognition, reduces aggression, and suppresses appetite. In addition, by promoting release of dopamine, nicotine activates the brain's "pleasure system" located in the mesolimbic area. The effects of nicotine on the pleasure system are identical to those of other highly addictive drugs, including cocaine, amphetamines, and opioids. Nicotine does not cause sleepiness or increase aggressiveness. p. 436
The nurse knows that which neurologic condition can be caused by the direct actions of alcohol or the nutritional deficiencies often seen in people with chronic alcoholism?
Wernicke's encephalopathy Rationale Wernicke's encephalopathy is caused by thiamine deficiency, which results from alcohol-induced suppression of thiamine absorption. It is characterized by confusion, nystagmus, and abnormal ocular movements. Panic disorder, bipolar disorder, and paranoid schizophrenia are not caused by the nutritional deficiencies seen in patients with chronic alcoholism. p. 424