Abrams Ch. 58 - Substance Abuse Q's

A nurse is instructing a client who's to receive disulfiram (Antabuse). Which statement by the client demonstrates that the teaching was effective? A. "I can use any aftershave." B. "I can use any antacids." C. "I can use any cough syrups." D. "I can use any mouthwash."

B. "I can use any antacids." Antacids don't interact with disulfiram. The client should avoid anything containing alcohol, including aftershave lotion and some cough medicines and mouthwashes.

While the school nurse is providing health education to a group of children on the dangers of illicit drug use, a child asks the nurse what sniffing gasoline or glue does to the body. What response is most effective in addressing this question? A. "The most serious effects are the damage to the nostrils and sinuses." B. "It depends on what a person sniffs and how often they do it." C. "Doing that damages the brain and other body organs." D. "Let's talk about why you would want to sniff these substances."

C. "Doing that damages the brain and other body organs." Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Comparatively, damage to the nose is less significant. Damage is dose dependent, but it would be most appropriate to address possible areas of harm. While exploring the reasons behind the activity is appropriate, it does not address the question.

A female client presents to the emergency department confused and disheveled and states that she was raped. She attended a party earlier in the evening. What substance, often called a date rape drug, might have been added to her drink? A. THC B. Cocaine C. GHB D. Ketamine

C. GHB Usage of GHB has increased in recent years, mainly in the party or dance-club setting, and GHB is increasingly involved in poisonings, overdoses, date rapes, visits to hospital emergency departments, and fatalities.

A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client? A. Antidepressants B. Beta adrenergic antagonists C. Antibiotics D. Benzodiazepines

D. Benzodiazepines Benzodiazepines are the drugs of choice for treating withdrawal from alcohol and other CNS depressants. Beta adrenergic antagonists or beta blockers lower the blood pressure. Antidepressants work for those with depression. Antibiotics are used for infections.

The triage nurse in the emergency department admits a client in distress. The client's parents attribute the client's distress to amphetamine use. What assessment finding would best corroborate this parent's suspicion? A. Drowsiness, arousable by touch B. Dilated pupils, unresponsive to light C. Heart rate 96 beats/min, regular rhythm D. Blood pressure 196/117 mm Hg

D. Blood pressure 196/117 mm Hg Increases in blood pressure, tachycardia, insomnia, and restlessness are symptoms of amphetamine abuse. Pupil response is not normally affected by amphetamines, unlike narcotics. The client is more likely to be agitated than drowsy.

The nurse is coordinating care for a client with a longstanding substance use disorder. The client has engaged with a support group and has been prescribed acamprosate 666 mg PO TID. When planning this client's care, what is the most appropriate goal of care? A. Client will abstain from nonprescription opioids. B. Client will safely detoxify from opioid dependence. C. Client's liver enzymes will remain within reference ranges. D. Client will abstain from alcohol use.

D. Client will abstain from alcohol use. Acamprosate is prescribed exclusively to prevent the cravings for alcohol that are associated with alcohol abuse. This medication is not used in the treatment of opioid addiction since it does not have the same anti-craving effect. The goal about the client's liver enzymes is also relevant to a client with a history of alcohol abuse, but abstinence from alcohol is the highest priority goal which will promote other secondary benefits, such as liver health.

The nurse working in the emergency department admits a client who arrived by ambulance and has respirations of 8 to 12 breaths per minute. The EMTs report finding an empty pill container of diazepam next to the client. The nurse anticipates administering what drug to this client? A. Haloperidol B. Chlordiazepoxide C. Naloxone D. Flumazenil

D. Flumazenil Flumazenil is the antidote for benzodiazepine overdose.

Which of the following symptoms may be present during severe alcohol withdrawal? A. Hypothermia B. Bradycardia C. Hyperventilation D. Seizures

D. Seizures Signs and symptoms of alcohol withdrawal include agitation, anxiety, tremors, sweating, nausea, tachycardia, fever, hyperreflexia, postural hypotension, and, if severe, convulsions and delirium. Antiseizure drugs are typically ordered if seizures are repeated or continuous.

Charlie, a homeless heroin addict, has been admitted into care and needs immediate intervention. A visiting health care provider has begun Charlie on methadone maintenance. What fact should the nurse consider during this client's treatment for substance use? A. Methadone is expected to be soon banned in the United States. B. Methadone is an ineffective drug. C. Methadone has a short duration of action. D. Using methadone maintenance may lead to a dependence on methadone.

D. Using methadone maintenance may lead to a dependence on methadone. Methadone is an opioid with a dependence-producing liability. Although oral methadone dosing suppresses opioid withdrawal symptoms and the drug has a long duration of action, there is a risk of the client developing a dependence on methadone.

A client asks why medication therapy for the treatment of drug dependence is limited. Which statements correctly address the client's question? Select all that apply. A. "Treatment programs emphasize sobriety." B. "Drug therapy can be prescribed by counselors." C. "There are limited specific antidotes for drug dependence." D. "Benzodiazepines are used for most substance abuse disorders." E. "A combination of drug therapy and counseling is most effective."

A. "Treatment programs emphasize sobriety." C. "There are limited specific antidotes for drug dependence." E. "A combination of drug therapy and counseling is most effective." Drug therapy for treatment of drug dependence is limited for several reasons. There is a high risk of substituting one abused drug for another. There are significant drawbacks to giving CNS stimulants to reverse effects of CNS depressants and vice versa. There is often inadequate information about the types and amounts of drug taken. Two of the most successful drug therapy regimens are methadone administration for heroin dependence and nicotine replacement for nicotine dependence. With both treatments, however, a combination of drug therapy and counseling is more effective than either method alone. Treatment programs for substance abuse and dependence emphasize sobriety with complete abstinence from substance use. Combined with psychotherapy, there are pharmacological interventions that can assist with sobriety. Drug therapy is prescribed by certified prescribers, not usually counselors. Specific antidotes are available only for benzodiazepines and opioid narcotics.

A client is experiencing agitation, nervousness, and hyperactivity while in withdrawal from substance addiction. Which type of substance abuse is characterized by these behaviors? Select all that apply. A. Alcohol B. Opioid C. Marijuana D. Tricyclic antidepressant E. Benzodiazepine

A. Alcohol B. Opioid E. Benzodiazepine Withdrawal symptoms of agitation, nervousness, and hyperactivity are associated with alcohol and sedative-like drugs such as benzodiazepines and opioids. Marijuana is not a sedating drug. Tricyclic antidepressants are used for depression.

A client has admitted to the emergency department in alcohol withdrawal and has been administered two doses of chlordiazepoxide. The nurse has assessed the client who is staring ahead blankly and states that he feels "utterly exhausted" when the nurse asks how he is feeling. What is the nurse's best action? A. Document this expected therapeutic effect of the medication. B. Ensure the client does not fall asleep. C. Administer a dose of chlordiazepoxide as prescribed. D. Assess the client's typical patterns of alcohol use.

A. Document this expected therapeutic effect of the medication. The client's absence of agitation combined with the ability to respond to questions suggests an absence of delirium. This is among the intended therapeutic effects of chlordiazepoxide. There is no obvious indication of the need for subsequent doses. Sleep would not pose a safety risk and it would likely be premature to explore the client's long-term patterns of addiction during the immediate phase of detoxification and stabilization.

A client has lived with alcohol addiction for many years, and has relapsed after each attempt to stop drinking. The client has now been prescribed disulfiram. What education should the nurse provide to the client? A. Drinking even small amounts of alcohol will cause illness. B. The medication prevents the client from experiencing any effects of alcohol intake. C. A dose should be taken promptly if the client drinks alcohol. D. This medication will eliminate cravings for alcohol.

A. Drinking even small amounts of alcohol will cause illness. The combination of disulfiram with alcohol may result in headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. The medication does not directly eliminate cravings and it must not be taken within 12 hours of drinking alcohol.

A client has been abusing heroin for several years and has suffered many physical and social consequences of addiction. The client has begun engaging with a recovery group and began methadone treatment a few weeks ago. During the nurse's most recent assessment, the client reluctantly acknowledges relapsing with cocaine and heroin use over the past three days. What is the nurse's priority action? A. Inform the care team of the client's actions. B. Provide empathy and dialogue about the client's understanding of the relapse. C. Administer naloxone as prescribed. D. Maintain the client's confidentiality and monitor closely.

A. Inform the care team of the client's actions. While the nurse must persist in a therapeutic relationship with the client, including the expression of empathy, the client's action constitutes a safety threat and the care team needs to be aware. There is no evidence of acute physical distress, so naloxone is not warranted.

A patient arrives at the emergency department accompanied by a friend. The friend states that the patient was found stumbling and vomiting, with slurred speech. The nurse observes sores around the patient's mouth and a chemical odor of the breath. What does the nurse suspect the patient has been using? A. Inhalants B. Anabolic androgenic steroids C. Designer drugs D. Alcohol

A. Inhalants The nurse should suspect inhalant abuse when observing paint or stains on the body or clothing, spots or sores around the mouth, red or runny eyes and nose, chemical odor on the breath, a drunken or dazed appearance, loss of appetite, excitability, and irritability.

When questioned about her alcohol usage, a female client states that she drinks three martinis a night. What assessment should the nurse make of this statement? A. She may have understated the amount of alcohol consumed. B. She normally consumes four to six martinis a night. C. This is the correct amount consumed. D. She is giving information she expects the nurse expects to hear

A. She may have understated the amount of alcohol consumed. Abusers of alcohol and other drugs are not reliable sources of information about the types or amounts of drugs used. Most abusers understate the amount and frequency of substance use.

The nurse is caring for a client for whom a psychological therapy has been ordered to assist with recovery from an addictive disorder. The nurse understands that what statement is true about psychological rehabilitation efforts? A. They should be part of any treatment program for a drug-dependent person. B. They do not make an impact on addiction treatment because it is a physical dependence. C. They are successful when used in facility-based rehabilitation programs. D. They are rarely covered by health insurance.

A. They should be part of any treatment program for a drug-dependent person.

When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for? A. sedation B. anxiety C. insomnia D. increased thirst

A. sedation The side effects of benzodiazepines are sedation, confusion, restlessness, bradycardia, tachycardia, urinary retention or incontinence, and drug dependence. The nurse should observe the client for excessive sedation and should use benzodiazepines cautiously in clients with impaired kidney or liver function. Insomnia, increased thirst, and anxiety are common side effects in drugs used in recovery from chemical dependence, but are not most commonly associated with benzodiazepines.

The nurse is caring for a client suspected of ketamine abuse. What characteristic behavior would the nurse expect to observe? A. sensory hallucinations B. euphoria C. increased physical strength D. catatonia

A. sensory hallucinations Ketamine is a general anesthetic that is chemically related to PCP and used during induction or maintenance of general anesthesia. Ketamine causes distorted senses and perceptions as well as dissociative reactions. These effects produce a high risk of injuries. Abnormal strength, euphoria, and catatonia are not characteristic effects of this medication.

The nurse is talking with a patient who is in the hospital from complications related to alcoholism. The patient states, "My father and grandfather were alcoholics. Do you think this is why I am?" What is the best response by the nurse? A. "Many studies say that certain genes can cause alcoholism." B. "Whatever the reason for your alcoholism, you need to quit drinking. It will kill you at this rate." C. "You are an alcoholic because you choose to drink." D. "There is no proof that alcoholism is hereditary."

A. "Many studies say that certain genes can cause alcoholism." Genetic factors also play an important role in drug dependence. Certain genes may predispose a person to, or protect the person from alcoholism. Several studies emphasize the effects of heredity and maintain that the disease of addiction is a consequence of genetic deficiencies in brain tissues or neurotransmitters.

The nurse is taking a history from a patient who states that she smokes marijuana daily. The patient says, "It mellows me out and helps me to cope with the stresses of life. I go sometimes without it and it doesn't bother me." What does the nurse determine is this patient's issue with the substance? A. The patient has developed a psychological dependence for marijuana. B. The patient is tolerant to the effects of the marijuana. C. The patient will soon develop physical dependence on other substances in this class of drug. D. The patient has developed a physical dependence on marijuana.

A. The patient has developed a psychological dependence for marijuana. Psychological dependence, thought by some experts to be the most important factor in addiction, involves the compulsive use of and craving for a drug. It results from the direct influence of drugs on the brain chemistry. The drug causes an altered state of consciousness and distorted perceptions that are pleasurable and satisfying to the user. Patients with a psychological addiction are motivated by the feelings the drug provides, rather than the body's need of the drug.

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order? A. chlordiazepoxide B. bupropion C. varenicline D. cannabis

A. chlordiazepoxide Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants. Varenicline and bupropion are used for smoking cessation. Cannabis is medical marijuana and not used for acute alcohol withdrawal.

After reviewing the various frequently abused street drugs, a group of students demonstrates understanding of the information when they identify gamma-hydroxybutyrate as which class? A. depressant B. stimulant C. opioid D. hallucinogen

A. depressant Gamma-hydroxybutyrate, or GHB, is a depressant. Cocaine or methamphetamine is considered a stimulant. LSD or MDMA is considered a hallucinogen. Fentanyl, morphine, or OxyContin is an opioid.

The nurse is assessing a client who takes benzodiazepines for the treatment of anxiety disorder. The client has presented nonresponsive and the client's partner reports he has recently taken oxycodone recreationally. The nurse should place the highest priority on what assessment? A. respiratory function B. motor function C. blood pressure and heart rate D. neurologic assessment

A. respiratory function The nurse would include each of these assessments because each would be affected by the client's medication use. However, the combination of benzodiazepines and opioids presents a profound threat to the client's respiratory function and oxygenation. For this reason, respiratory assessment would be the highest priority.

The high school nurse is explaining the dangers of substance abuse to the incoming freshman class. How would the nurse explain psychological dependence to the students? A. "It involves the unpleasant symptoms that result when you stop taking the drug." B. "It involves feelings of satisfaction and pleasure from taking the drug." C. "It is the decreased effect of the drug that occurs with extended use." D. "It is the physiologic adaptation to chronic use of a drug."

B. "It involves feelings of satisfaction and pleasure from taking the drug." Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug-abuse patterns, and return to drug-taking behavior after periods of abstinence. Physiologic adaptation to chronic use of a drug is physical dependence. Withdrawal results in unpleasant symptoms that occur when a physically dependent person stops taking a drug. Tolerance causes a decrease in the effects of a drug in a drug-dependent person, requiring increased doses to achieve the desired psychological effects or to avoid withdrawal.

The nurse is caring for a client who had abdominal surgery 1 day ago. The client is reluctant to get up and ambulate because of the pain. The nurse encourages the client to take the prescribed medication (morphine sulfate) and then ambulate with assistance. The client refuses because of fear of becoming addicted to the medication. What is the nurse's best response to this client? A. "I will only give you half of the dose, so it will decrease your chance of addiction." B. "Most people who receive pain medications because of a medical reason don't become addicted to the medication." C. "Why are you worried about this? Have you had an addiction problem in the past?" D. "I will ask the health care provider if I can give you acetaminophen for the pain."

B. "Most people who receive pain medications because of a medical reason don't become addicted to the medication." Clients who receive opioid medications such as morphine sulfate do not usually experience addiction once the reason for the pain has gone.

An adult client has a long history of alcohol abuse and has been through many cycles of attempted recovery followed by relapse. The client's health care provider has prescribed naltrexone to the interdisciplinary care plan. What desired outcome should the nurse document in the client's care plan on the basis of this new prescription? A. Client will not exhibit CNS depression after drinking alcohol. B. Client will report reduced cravings for alcohol consumption. C. Client will report an absence of euphoria after consuming alcohol. D. Client will experience unpleasant physiologic effects after consuming alcohol.

B. Client will report reduced cravings for alcohol consumption. Naltrexone is shown to reduce alcohol cravings in some clients. It does not produce physiologic effects such as illness after alcohol use, mitigation of CNS depression, or absence of euphoria if the client happens to consume alcohol.

The patient states that he took LSD approximately 1 month ago and feels like he is "going crazy." What effects of the use of hallucinogens may be experienced days to years after taking LSD? A. Depression B. Flashbacks C. Schizophrenia D. Mania

B. Flashbacks Flashbacks are hallucinatory episodes that occur days to years after taking a drug and occur with the use of LSD and PCP. Prolonged psychotic episodes (lasting several days to several months) with visual hallucinations have been precipitated by LSD and PCP.

Which of the following medication is a narcotic antagonist? A. Methadone (Dolophine) B. Naloxone (Narcan) C. Clonidine (Catapres) D. Oxycodone (Oxycontin)

B. Naloxone (Narcan) Narcan is a narcotic antagonist. Dolophine is a synthetic narcotic. Catapres is a alpha-adrenergic blocker. Oxycontin is a opiate drug.

The triage nurse in the emergency department treats a patient and suspects the patient is abusing amphetamines. While assessing this patient, what would the nurse be likely to find? A. The patient is drowsy. B. The patient has hypertension. C. The patient is elated. D. The patient is bradycardic.

B. The patient has hypertension. Increase in blood pressure, tachycardia, and insomnia are symptoms of amphetamine abuse. Elation can indicate abuse of cannabis.

What is a major reason for the illicit use of gamma-hydroxybutyrate (GHB)? A. To treat insomnia B. To stimulate muscle growth C. To self-medicate depression D. To promote concentration

B. To stimulate muscle growth GHB is available for medical use (as sodium oxybate) for the treatment of narcolepsy. GHB is sometimes used illicitly by bodybuilders for alleged anabolic effects. It is better known, however, for its illegal use as a "date rape" drug. Promotion of concentration and treatment of depression are not reasons for its illicit use.

A client admits to smoking marijuana several times a day but denies being dependent on the drug. The nurse should base the discussion with the client on what characteristic of psychological dependence? A. There is a need to increase frequency of medication usage to achieve desired effects. B. Using the drug creates the feeling of satisfaction and pleasure. C. Stopping the drug results in unpleasant symptoms. D. Laboratory findings are congruent with frequent intoxication.

B. Using the drug creates the feeling of satisfaction and pleasure. Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug abuse patterns, and return to drug-taking behavior after periods of abstinence. Physical dependence results in unpleasant symptoms when the drug is stopped. Laboratory findings congruent with frequent intoxication would be further evidence of physical dependence. Tolerance is the need to increase drug usage to obtain the desire effect. The other options are also related directly to physiologic dependency.

The emergency room nurse is admitting a client brought in after exhibiting threatening and unpredictable behavior, suspected to be the result of a recent binge of methamphetamine use. In addition to ensuring the client's immediate safety and that of others, what is the nurse's priority action? A. initiating a program aimed at long-term abstinence B. facilitating detoxification C. screening the client for addiction D. mobilizing the client's support system

B. facilitating detoxification All of the listed actions are relevant to the client's short-term and long-term well-being. However, the immediate priority is to assist with the process of detoxification, since this poses an immediate threat to the client's short-term physical and psychosocial status. Once detoxification has been safely achieved, the nurse can facilitate the other measures aimed at longer-term benefits.

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for: A. increased appetite. B. hypertension. C. bradycardia. D. stupor.

B. hypertension. Methamphetamine is a CNS stimulant that initially increases heart rate and blood pressure. This drug usually decreases appetite, energizes muscles, and causes some degree of mental and physical alertness.

A client has been deemed a candidate for methadone therapy. What instruction should the nurse provide when preparing the client for this treatment plan? A. "You can take your methadone pills at any time, but it's important that it be on an empty stomach." B. "The doctor will prescribe 1 weeks' worth of methadone at a time." C. "You'll need to come to the clinic to get your daily dose of methadone." D. "For the first few weeks, you'll need to come to the outpatient clinic for an intravenous (IV) dose of methadone."

C. "You'll need to come to the clinic to get your daily dose of methadone." Methadone is usually given in a single, daily oral dose at an outpatient methadone clinic. Neither IV dosing nor food restrictions are required. Dosing is provided on a daily basis to avoid abuse behaviors.

As an adjunct to a client's alcohol withdrawal management program, the health care provider orders disulfiram. The nurse is responsible for the client's education program. When the client arrives home after discharge, the client pours a beer. What symptoms would the client expect to experience? (Select all that apply.) A. Paranoia, mania, and depression B. Hypotension, anemia, and confusion C. Blurred vision, headache, and chest pain D. Sweating, nausea, and vomiting E. Flushing, tachycardia, and garlic aftertaste

C. Blurred vision, headache, and chest pain D. Sweating, nausea, and vomiting E. Flushing, tachycardia, and garlic aftertaste The combination of disulfiram with alcohol may result in headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. More severe effects with alcohol) include arrhythmias, cardiovascular collapse, heart failure, myocardial infarction, and death.

Nurses can help prevent drug abuse by all of the following EXCEPT: A. Administering drugs appropriately. B. Teaching clients about drugs prescribed for them. C. Demanding drug testing for all clients. D. Using nondrug measures when possible.

C. Demanding drug testing for all clients. Because substance abuse often starts during childhood and adolescence, health professionals, parents, teachers, and others need to teach children about risks of drug abuse and strategies to resist peer pressure to use drugs of abuse; limit access to drugs of abuse; and support programs and activities designed to decrease drug abuse in this population. Nurses can help prevent drug abuse by administering drugs appropriately, using nondrug measures when possible, teaching clients about drugs prescribed for them, and participating in drug education programs.

There are several reasons why drug therapy is of limited use in treating substance dependence. Which of the following statements accurately describes a potentially serious risk of such therapy? A. The patient may not want to undergo drug therapy. B. The therapy is usually ineffective. C. Drug therapy could substitute one abused drug for another. D. The wide range of antidotes makes selection of the appropriate treatment drug difficult.

C. Drug therapy could substitute one abused drug for another. One of the main limitations in using drug therapy to treat dependence is the high risk of substituting one abused drug for another. A second limitation is that specific antidotes are available only for benzodiazepines and opioid narcotics.

Which major cardiovascular problem may occur in a client with chronic alcoholism? A. Pericarditis B. Arteriosclerosis C. Heart failure D. Heart valve damage

C. Heart failure Heart failure is a severe cardiac consequence associated with long-term alcohol use. Arteriosclerosis, heart valve damage, and pericarditis aren't medical consequences of alcoholism.

A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following? A. Diarrhea B. Bradycardia C. Nausea D. Slight headache

C. Nausea The effectiveness of Antabuse relies on a drug interaction between ethanol and disulfiram to produce unpleasant and undesirable symptoms as a deterrent to alcohol ingestion. Symptoms include facial flushing, throbbing headache, hyperventilation, tachycardia, palpitations, nausea and copious vomiting, hypotension, shortness of breath, vertigo, syncope, confusion, and profuse diaphoresis.

A client diagnosed with a substance use disorder asks the nurse why it is necessary to attend counseling in addition to taking the prescribed medication. What statement should inform the nurse's response? A. Discussion with the health care provider is needed to eliminate the counseling component of therapy. B. Counseling will address the underlying psychological disorder triggering the abuse behavior. C. Plans that combine methods of therapy are typically more successful. D. There is no effective method of treating drug addiction.

C. Plans that combine methods of therapy are typically more successful. Overall, treatment regimens that combine counseling and behavioral therapy with drug therapy are more successful than those using drug therapy alone. This does not mean, however, that psychological disorders always underlie addiction. While discussion with the health care provider is strongly suggested, it is not binding.

A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior? A. Physical dependence B. Withdrawal C. Psychological dependence D. Tolerance

C. Psychological dependence The client is describing psychological dependence which involve feelings of satisfaction and pleasure from taking a drug. These feelings of dependence return the client to drug-taking behavior after periods of abstinence. Physical dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating a person continues to use a substance of abuse despite significant substance-related problems. Tolerance is the need for increasingly larger or more frequent doses of a substance to obtain the desired effects originally produced by a lower dose. Withdrawal is development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitant due to the cessation of or reduction in heavy and prolonged substance use.

During his assessment, Drew reveals that he is a frequent user of crack and has been on a binge for several days. The nurse realizes that he requires frequent cardiac assessments. The reason for this increased assessment of the cardiac system is because of the major risk for what condition as a result of crack cocaine use? A. Hepatotoxicity B. Renal ischemia C. Rupture of the aorta D. Nasal mucosal atrophy

C. Rupture of the aorta While nasal mucosal atrophy, hepatotoxicity, and renal ischemia are common adverse effects of cocaine, a person using crack faces an additional, usually fatal risk of sudden death due to acute myocardial infarction or rupture of the aorta. Cocaine sensitizes cardiac cells and causes an increase in contractility. Corresponding high levels of epinephrine secondary to excitement from cocaine cause the individual to be particularly susceptible to cardiac arrest.

A family expresses concern when a family member withdrawing from alcohol is given lorazepam (Ativan). What information should be given to the family about the medication? A. The medication helps in the treatment of coexisting diseases, such as cardiac problems and hypertension B. The medication will help the client forget about the physical sensations that accompany alcohol withdrawal C. The medication is given for a short time to help the client complete the withdrawal process D. The medication promotes a sense of wellbeing during the client's difficult withdrawal period

C. The medication is given for a short time to help the client complete the withdrawal process Lorazepam is a short-acting benzodiazepine that may be given for 1 week to help the client in alcohol withdrawal. However, there's some debate over its use due to a potential risk for cross-addiction. The medication isn't given to help forget the experience; it lessens the symptoms of withdrawal. It isn't used to treat coexisting cardiovascular problems or promote a sense of well-being.

A 28-year-old patient comes into the emergency department with chest pain. The client's blood pressure is 170/108, heart rate 116, and respiratory rate 32. The client states having "used drugs." The nurse would question the client about the use of: A. benzodiazepines. B. barbiturates. C. cocaine. D. opioids.

C. cocaine. The most commonly abused CNS stimulants include cocaine and methamphetamine. These CNS stimulants initially increase heart rate and blood pressure. Excess amounts can cause insomnia, hypertension, and cardiovascular problems.

The hospital nurse is responding to a code blue where a client is believed to have overdosed on an unknown opioid. The team administered naloxone 2 mg IV to the client 2 minutes ago with no appreciable improvement in respiratory function or level of consciousness. What is the nurse's most appropriate action? A. Reposition the client and monitor closely for 2 more minutes. B. Prepare naloxone 10 mg IV for administration as soon as prescribed. C. Prepare epinephrine IV for administration as soon as prescribed. D. Anticipate the immediate administration of another dose of naloxone.

D. Anticipate the immediate administration of another dose of naloxone. If therapeutic effect is not achieved with an initial dose of naloxone, it may be administered at 2-3 minute intervals. However, subsequent doses would be similar in quantity to the initial dose, not 10 mg. Epinephrine will not mitigate the effects of an opioid overdose. Repositioning and monitoring would be insufficient responses, since the client requires an opioid antagonist to resume respiratory function.

As a school nurse, you are preparing to do a presentation on cannabis and the long-term sequelae of its heavy use. To what body system or function do you understand cannabis use can cause the most damage? A. Cardiovascular B. Blood pressure C. Liver D. Brain

D. Brain Cannabis use causes the greatest damage to the brain. This is because cannabinoid receptors are concentrated most heavily in the cerebellum, the part of the brain that controls motor coordination, and in the hippocampus, which governs learning and memory.

The neonatal nurse is providing care for an infant whose medication regimen includes methadone 1.5 mg/kgPO q12h. What desired outcome should the nurse most likely include in the infant's plan of care? A. Client's vital signs will remain within reference ranges. B. Client will remain free of signs and symptoms of pain. C. Client will require less than 0.05 mg/kg morphine for pain control. D. Client will remain free of signs of opioid withdrawal.

D. Client will remain free of signs of opioid withdrawal. Methadone can be used to treat neonatal opioid withdrawal syndrome. An absence of the associated signs and symptoms would be considered a desired outcome of this treatment. Assessment would include vital signs but would also go further to include the varied signs and symptoms of withdrawal. Methadone is not normally used for pain control in infants and would not be used to complement morphine.

Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine? A. Serotonin B. Acetylcholine C. Epinephrine D. Dopamine

D. Dopamine Dopamine is the neurotransmitter that is most likely responsible for the rewarding and reinforcing effects of cocaine. Serotonin, epinephrine, and acetylcholine are not responsible for the rewarding and reinforcing effect of cocaine.

A 19-year-old male client arrives at the emergency department with his friend. His friend states that they were smoking marijuana and the client suddenly began having hallucinations, began exhibiting bizarre behavior, and then became unconscious. The nurse finds that the client is hypertensive and suspects that the marijuana was laced with what substance? A. GHB B. THC C. Ketamine D. PCP

D. PCP Phencyclidine (PCP) produces excitement, delirium, hallucinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired thought processes; impaired motor skills; psychotic reactions; sedation and analgesia; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death. Death from overdose also has occurred as a result of respiratory depression. Bizarre murders, suicides, and self-mutilations have been attributed to the schizophrenic reaction induced by PCP, especially in high doses. The drug also produces flashbacks.

Which of the following is a clinical manifestation of alcohol withdrawal? A. Hypotension B. Bradycardia C. Dry skin D. Seizures

D. Seizures A clinical manifestation of alcohol withdrawal include seizures. Tachycardia, hypertension, and diaphoresis are additional clinical manifestations.

A client was prescribed oral hydromorphone two weeks ago for the treatment of cancer pain. The client was able to achieve pain relief with 2 mg doses for the first 10 days, but has recently needed 3-4 mg to achieve the same effect. The client has expressed concern to the nurse that he is becoming addicted to hydromorphone. What should the nurse teach the client? A. The client will not become addicted because the medication has a legitimate use. B. The client is likely developing a psychological dependence on morphine. C. There are interventions available to treat early addiction. D. The client is developing a tolerance, which is not the same as addiction.

D. The client is developing a tolerance, which is not the same as addiction. Tolerance is characterized by needing larger doses of a medication to achieve the effect that lower doses produced in the past. The client has not described the feelings of satisfaction and euphoria that characterize psychological dependence. Even though the client is taking this medication for legitimate reasons, this does not mean that addiction is not possible. There are indeed interventions to address addiction, but this is not a necessary teaching point at this time because there are no obvious signs of addiction.

What happens when clients return to opiate abuse while taking naltrexone? A. They experience depression and are prone to commit suicide B. They experience physiologic consequences of withdrawal C. They have an increased potential for overdosage and death D. They do not experience the previous level of opiate effects

D. They do not experience the previous level of opiate effects Naltrexone is used for opiate addiction. When clients return to opiate abuse while taking naltrexone, they do not experience the previous level of opiate effects. They do not have increased potential for overdose and death. In addition, they do not experience any physiologic consequences of withdrawal and are not depressed and prone to commit suicide. To clarify, naltrexone can put a patient into precipitated withdrawal, but since the naltrexone came first before the opioid in this situation, the blockage of opioid receptors by naltrexone will prevent the exogenous drug from taking hold in the body. Consequently, the drug won't have its previous effects. It's when the naltrexone comes as a reaction to the opioid consumption that the precipitated withdrawal is an issue, because the receptors formerly had that bond with the opioid that's then severed. Precipitated withdrawal doesn't happen as drastically with naltrexone as it does with naloxone.

The nurse is taking a health history from a patient in the clinic and asks about the use of alcohol. The patient states that he drinks approximately a case of beer on some weekends. What does the nurse understand about this type of substance use? A. This patient has developed a tolerance to alcohol and needs more to become intoxicated. B. This patient has a cross dependence and most likely abuses other substances. C. This patient is addicted to alcohol and will have withdrawal symptoms if he does not have the alcohol. D. This patient abuses alcohol on weekends; this is considered substance abuse.

D. This patient abuses alcohol on weekends; this is considered substance abuse. Substance abuse is the inappropriate and usually excessive self-administration of a drug substance for nonmedical purposes.

Which of the following refers to the reduction in a drug's effect that follows persistent use? A. Addiction B. Withdrawal C. Dependence D. Tolerance

D. Tolerance Tolerance refers to the reduction in a drug's effect that follows persistent use. Addiction is drug-seeking behaviors that interfere with work, relationship, and normal activities. Withdrawal refers to the physical symptoms and craving for a drug that occur then a person abruptly stops using an abused substance.

A client with chronic pain was prescribed oxycodone several months ago and has developed a tolerance, requiring gradual increases in dose. As well, the client admits to experiencing psychological dependence and is showing signs and symptoms of physical dependence. The nurse should advocate for what approach? A. education about strategies to overcome medication tolerance B. education about how to use PRN naloxone in case of overdose C. prompt discontinuation of the medication and liberal use of NSAIDs D. close monitoring and gradual tapering down of the dose

D. close monitoring and gradual tapering down of the dose Opioid-dependent clients should have their dose gradually reduced, under close supervision. Tolerance is a purely physiologic phenomenon and is not something that can be overcome with education (unlike psychological dependence or addiction). Abrupt discontinuation can result in pain, withdrawal, and physical distress. Naloxone is an emergency measure but does not address the client's underlying challenge.

The nurse who is working in the emergency department admits a 14-year-old client who is exhibiting blurred vision, confusion, impaired breathing, muscle twitches, irregular heartbeat, and excessive sweating. The client's friends report that the client bought a lot of cough syrup and has been drinking it all day. The nurse understands that the client has overdosed on what over-the-counter medication? A. guaifenesin B. acetaminophen C. ibuprofen D. dextromethorphan

D. dextromethorphan The client is experiencing symptoms of dextromethorphan overdose that include blurred vision, brain damage, confusion, dizziness, drowsiness, excessive sweating, hallucinations, impaired breathing, impaired judgment and mental functioning, loss of consciousness, loss of physical coordination, muscle twitches, nausea and vomiting, paranoia, rapid and irregular heartbeat, seizures, slurred speech, and death. The information provided does not support overdose with acetaminophen, ibuprofen, or guaifenesin.

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding: A. genetic factors. B. the client's perception of the admitting problem. C. family history of substance abuse. D. drug use.

D. drug use. Substance dependence denotes a maladaptive pattern of use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the resulting negative effects.

A client with a substance use disorder has been prescribed haloperidol 3.5 mg IM. The nurse obtains a vial of haloperidol 5 mg/mL. The nurse should draw up what quantity of the medication? (in mL)

0.7 mL 3.5/5=0.7

A client has been admitted to the emergency department with a suspected opioid overdose and has been prescribed naloxone 1 mg IV STAT. The medication is available in a 10 mL vial at a concentration of 4 mg/10 mL. How many mL should the nurse draw up? (in mL)

2.5 mL 10x0.25=2.5

The nurse at a community clinic administers methadone to clients in recovery from opioid addictions. A client is prescribed methadone 40 mg PO daily and the medication is available in an oral solution at 10 mg/5 mL. What quantity of methadone should the nurse administer? (in mL)

20 mL 5x4=20

Which drug would be classified as a hallucinogen? A. rohypnol B. PCP C. amyl nitrate D. heroin

B. PCP Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.