Addiction/substance abuse
a,d,e
A client admitted 3 days ago is now experiencing alcohol withdrawal delirium. Blood pressure is 100/60 mmHg, and pulse is 110 bpm. Tremor is noted, and the client is confused as to place and time. Which nursing intervention should be implemented to promote safety for the client during alcohol withdrawal? Select all that apply. a Assessing the client's level of orientation frequently b Encouraging the client to verbalize fears c Teaching the client healthy coping mechanisms d Using simple step-by-step instructions with the client e Explaining all interventions before approaching the client
c
A client asks what is accomplished by attending Alcoholics Anonymous (AA) meetings. Which is the nurse's best response? a "AA provides support and medication follow-up after your discharge. b "AA allows you to share responsibility for your recovery with your family. c "AA provides support from peers with the same addiction. d "AA is an optional recovery program for your family to cope with your alcoholism.
d
A client being seen for a routine checkup tells the nurse that her two children are doing poorly at school. She thinks that they might not be getting enough sleep because her husband frequently comes home late after drinking with his friends and wakes up the family. She doesn't want to say anything to him because "he works hard and needs to relax. " Which behavior is the client exhibiting? a Intervention b Confrontation c Collaboration d Codependence
b signs of mild barbiturate use include: nystagmus, diplopia, strabismus, slowness of speech and positive rhomberg sign
A client has a history of abusing barbiturates. Which of the following is a sign of mild barbiturate intoxication? a. rapid speech b. nystagmus c. anisocoria d. polyphagia
d divide bac by 20 to get amt metabolized per hr
A client is admitted with a BAC of 180 mg/dL The nurse recognizes that the alcohol in the clients system should be fully metabolized within: a. 3 hrs b. 5 hrs. c. 7 hrs. d. 9 hrs.
a Rationale Lorazepam (Ativan) is associated with minimizing discomfort and preventing such adverse outcomes as seizures. Naltrexone (ReVia, Depade) blocks pathways to the brain that trigger the feeling of pleasure, reducing the craving for alcohol. Disulfiram (Antabuse) is a form of aversion therapy that prevents the breakdown of alcohol, causing the symptoms of physical illness in an individual who consumes alcohol while taking the medication. Metoprolol tartrate (Lopressor) is useful in the treatment of esophageal varices if needed to reduce the risk of bleeding.
A client is brought into the emergency department for treatment of alcohol withdrawal. The client's daughter states, open double quote"My dad gave up drinking 2 days ago, and this evening he had a seizure and that's why I called the ambulance.close double quote" Which prescription should the nurse anticipate from the health care provider? a Lorazepam (Ativan), a benzodiazepine b Metoprolol tartrate (Lopressor), a beta-blocker c Naltrexone (ReVia, Depade), an opioid analgesic d Disulfiram (Antabuse), an alcohol antagonist
c Rationale Korsakoff syndrome is a brain disorder usually associated with heavy alcohol consumption. Delirium tremens is a medical emergency resulting from alcohol withdrawal. Alcohol poisoning is a toxic condition that results from excessive consumption of large amounts of alcohol in a very short period of time. Although the client's husband may have liver damage, she is not describing symptoms related to that condition.
A client is concerned that her husband, who has a long history of alcoholism, is losing his memory and experiencing personality changes. Which disorder will the nurse educate this client about based on this information? a Delirium tremens (DTs) b Cirrhosis of the liver c Korsakoff syndrome d Alcohol poisoning
a additional symptoms include severe headache, nausea, cardiac collapse, respiratory collapse, convulsions and death
A client taking the drug disulfiram (antabuse) is admitted to the ER. Which clinical manifestations are most indicative of recent alcohol ingestion? a. vomiting, HR 120, chest pain b. nausea, mild headache, bradycardia c. RR 16, HR 62, diarrhea d. Temp 101 F, tachycardia, RR 20
a,b,d,e
A client who requires mandatory court-ordered drug testing is seen in the clinic. Which options can the nurse use to fulfill this court-required drug testing for this client? Select all that apply. a Saliva testing b Serum level testing c Genetic testing d Hair testing e Urine testing
a,b,c,e Rationale The immediate high resulting from inhalant use causes lightheadedness, excitation, euphoria, and agitation. A sweet smell on the clothes is indicative of cannabis use, not inhalant use.
A client with a history of inhalant abuse is admitted to the hospital. What would the nurse expect to find during an assessment? Select all that apply. a Lightheadedness b Euphoria c Excitation d Sweet-smelling clothes e Agitation
d Rationale Confabulation is a characteristic of Korsakoff psychosis. Ataxia and abnormal eye movements are characteristics associated with Wernicke encephalopathy. Anuria is not associated with Korsakoff psychosis or Wernicke encephalopathy.
A nurse caring for a client admitted with alcohol dependence and thiamine deficiency recognizes which symptom as characteristic of Korsakoff psychosis? a Anuria b Abnormal eye movements c Ataxia d Confabulation
a
A nurse expects a client with a cocaine addiction would most likely be placed on which medication? a bromocriptine (parlodel) b. methadone c THC d Disulfiram (antabuse)
c Rationale The B-DAST determines the severity of alcohol abuse. The CIWA-Ar is used to monitor and medicate clients going through alcohol withdrawal. The MAST indicates a potentially dangerous pattern of alcohol abuse. The CAGE questionnaire signifies that a client has a problem with alcohol and may require treatment.
A nurse in the mental health unit is conducting an admission assessment on a client with alcohol abuse. The nurse includes which screening in the assessment to determine the severity of the alcohol abuse? a CIWA-Ar b CAGE c B-DAST d MAST
b,c,d,e Rationale A community assessment evaluates such resources to support recovery as mental health services, support groups, rehabilitation centers, and funding for local services. Although a college may be a community asset, it is not central to support for addiction recovery.
A nurse is conducting a community assessment as part of planning rehabilitation services for a recovering heroin addict. Which questions will the nurse include to gain information regarding available supports within the community? Select all that apply. a Is there a college in the community? b Are there any possible funding resources? c Is there a rehabilitation center to help the client resolve addiction behavior issues? d Is there a community mental health center? e What support groups are available in the community?
a
A nurse is conducting a physical assessment of a client with suspected substance abuse problems. Which finding may indicate the client is a substance abuser? a Early-onset dementia b Weight gain c Vital signs within normal limits d Short stature
b,c,e
A nurse is conducting an admission assessment on a client with alcohol abuse. The assessment findings include a recent fall at home, decreased appetite, complaints of blurred vision, and a denial that alcohol has negative effects on the body. When developing the plan of care for this client, the nurse should indicate which as an appropriate goal based on the assessment findings? Select all that apply. a The client will participate in support groups. b The client will maintain adequate nutrition. c The client will verbalize the negative effects of alcohol on the body. d The client will remain sober. e The client will remain free of injury.
a Rationale Maintaining an open airway is one of several nursing interventions for the client who abuses opiates. Reducing sensory stimuli and encouraging the client to keep the eyes open are nursing interventions for the client who abuses hallucinogens, inhalants, or cannabis. Addressing nasal irritation is a nursing intervention for the client who abuses cocaine.
A nurse is developing a plan of care for a client addicted to opiates. The nurse would recognize which nursing intervention as appropriate for the client who abuses opiates? a Maintaining an open airway b Encouraging the client to keep the eyes open c Addressing nasal irritation d Reducing sensory stimuli
b,c,d
A nurse working in the employee health clinic is aware that there are reasons why nurses are at high risk of developing substance abuse problems. Which are they? Select all that apply. a Spending time with co-workers outside work b Frequent contact with drugs c Easy access to drugs d Pressures in the workplace e Working 12-hour shifts
c
A patient is brought to the emergency department (ED) by a friend. The patient is unresponsive and respirations are slow and shallow. Which of the following is the priority intervention? a Check the patient's blood glucose level b Administer naloxone, per protocol c Administer 100% oxygen per nasal cannula d Ask the friend if they were using illicit drugs
d
A patient who has a history of chronic back pain requires a higher dose of an opioid medication in order to achieve adequate pain relief. The healthcare provider suspects that these findings are a result of which of the following? a Dependence b Pseudoaddiction c Addiction d Tolerance
c Rationale Lesbian women are at greater risk of alcohol and illicit drug abuse disorders. Religion and spirituality are associated with a lower risk of alcohol and substance addictions; therefore, a Buddhist nun would have a low risk. Muslim men are also not known to have an increased risk of alcohol abuse. Bisexual men are at a greater risk of illicit drug use, not alcohol abuse.
A student nurse is writing a research paper on addiction risk for a psychology class. Which sociocultural group will the student include as having a high risk of abusing alcohol? a Buddhist nuns b Muslim men c Lesbian women d Bisexual men
d
Alan Trazinski is an adolescent who goes to the school nurse complaining of a stomach ache. Which assessment finding would place Mr. Trazinski at risk of substance abuse? a Mr. Trazinski says he loves to drive a snowmobile very fast. b Mr. Trazinski says he is an Evangelical Christian. c Mr. Trazinski says he finds history class very difficult. d Mr. Trazinski says his father frequently hits him.
b Rationale The abuse of alcohol and prescription drugs among adults age 60 and older is one of the fastest-growing health problems in the United States. Diagnosis of substance abuse is often complicated by its symptoms appearing to be symptoms of such other disorders as diabetes, depression, and dementia. There are no indications that dementia is overdiagnosed. The nurse's interests are irrelevant.
An adult client expresses concern that her mother has seemed somewhat distracted and lethargic recently. She is concerned that her mother has dementia. In addition to other inquiries, why does the nurse ask the client about the possibility that her mother is abusing a substance? a The nurse is studying to be a Certified Substance Abuse Counselor. b Diagnosis of substance abuse is often complicated by its symptoms appearing to be symptoms of such other disorders as diabetes, depression, and dementia. c Dementia is an overdiagnosed disorder. d Substance abuse is a minimal problem in the elderly but should be ruled out.
d
Claire Burns, a registered nurse, is preparing a smoking cessation program at a local community center. Which type of addiction treatment is she likely to exclude from the program presentation? a Medication b Behavior therapy c Support groups d Family therapy
b
Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using? A Compensation B Denial C Suppression D Undoing
a
Harriet Romo, age 79, has returned to her primary care office for the third time in four months. Harriet presents with bruises on her arms and legs and says, "I just can't go on like this. My daughter says if I don't quit drinking, I'll need to find a new place to live." Which assessment question is most appropriate for the nurse to ask at this time? a "Are you interested in seeking help?" b "What are the living conditions in your neighborhood?" c "Are there any recreational centers for you to socialize with other people in your age group?" d "How do you plan to pay for treatment?"
c
Mr. Bender, a 68-year-old client, is being admitted to the surgical unit with a fractured hip sustained after a fall at home. Which assessment finding indicates the need to screen this client for potential alcohol abuse? a The client states that he is forgetful. b The client is confused at times about the date. c The client reports periods of time lost to memory. d The client complains of fatigue.
d
Mr. Sabin, a 38-year-old client, is experiencing alcohol withdrawal. The nurse should anticipate an order for which medication to prevent adverse outcomes? a Naltrexone (ReVia, Depade), an opioid analgesic b Disulfiram (Antabuse), an alcohol antagonist c Zolpidem (Ambien), a nonbenzodiazepine sedative d Lorazepam (Ativan), a benzodiazepine
c
Nurse Rob has observed a co worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co worker? A Ignore the co worker's behavior, and frequently assess the clients assigned to the co worker. B Make general statements about safety issues at the next staff meeting. C Report the coworker's behavior to the appropriate supervisor. D Warn the co worker that this practice is unsafe.
a
Nurse Tara is teaching a community group about substance abuse. She explains that a genetic component has been implicated with which of the following commonly abused substances? A Alcohol B Barbiturates C Heroin D Marijuana
c
Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in: A abdominal cramps and diarrhea. B drowsiness and decreased respiration. C flushing, vomiting, and dizziness. D increased pulse and blood pressure
b Wernicke's encephalopathy is a CNS disorder caused by acute thiamin deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium. Cardiovascular and gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamin deficiency. Respiratory problems are not usually directly related to alcohol.
Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamin deficiency? A Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels B CNS symptoms, such as ataxia and peripheral neuropathy C Gastrointestinal symptoms, such as nausea and vomiting D Respiratory symptoms, such as cough and sore throat
a
Sandy O'Connor, age 51, tells the nurse in a primary care clinic that her husband is in danger of losing his job because of alcohol-related absences. She says that he refuses to acknowledge the problem and she doesn't know what to do. Which suggestion by the nurse is most appropriate to share with Mrs. O'Connor? a Mrs. O'Connor could initiate a family intervention. b Mrs. O'Connor could admit her husband to the hospital. c Mrs. O'Connor could divorce her husband. d Mrs. O'Connor could ignore the problem and just focus on her own life.
b BAC's with concentrations 400-600 are associated with resp depression, coma and death
The BAC of a client admitted with following a MVA is 460 mg/dL The nurse should give priority to monitoring the client for: a. loss of coordination b. respiratory depression c. visual hallucinations d. tachycardia
b
The client is admitted for observation because of ingestion of hallucinogenic drugs. Which statement is true regarding hallucinogenic drugs? a. hallucinogenic drugs create both stimulant and depressive effects b. hallucinogenic drugs induce a state of altered perception c. hallucinogenic drugs produce severe respiratory depression d. hallucinogenic drugs induce rapid physical dependance.
d
The client on an inpatient unit shares with the nurse that he drinks alcohol only twice a month, but that when he does, he drinks extremely large amounts at one sitting. The nurse recognizes this behavior as which pattern of dependence? a Social drinking b Abstinence drinking c Benchmark drinking d Binge drinking
a.c.d.f
The healthcare provider is screening a patient for alcohol abuse. Which of the following are part of the CAGE Questionnaire? Select all that apply. a Have people annoyed you by criticizing your drinking? b Have you ever neglected your family or missed work because of your drinking? c Have you ever felt bad or guilty about your drinking? d Have you ever had a drink first thing in the morning as an eye opener? e Have you ever lost friends because of your drinking? f Have you ever felt you should cut down on your drinking?
a
The newly hired nurse at Nurseslabs Medical Center is assessing a client who abuses barbiturates and benzodiazepine. The nurse would observe for evidence of which withdrawal symptoms? A Anxiety, tremors, and tachycardia B Respiratory depression, stupor, and bradycardia C Muscle aches, cramps, and lacrimation D Paranoia, depression, and agitation
d Rationale Withdrawal from amphetamines produces disorientation, as well as craving, fatigue, sleepiness, and depression. The symptoms of weight loss, tachycardia, and paranoia are associated with the abuse of amphetamines, not withdrawal from amphetamines.
The nurse anticipates that a client admitted for amphetamine addiction will develop withdrawal symptoms. The nurse caring for this client would monitor for which symptom? a Tachycardia b Weight loss c Paranoia d Disorientation
b,c,e Rationale During withdrawal from CNS depressants, nonpharmacologic treatment includes keeping the client awake, inducing vomiting, and using activated charcoal to absorb the drug. Vital signs are taken more frequently than hourly and should be monitored every 15 minutes. Group therapy would be beneficial after the withdrawal of the substance.
The nurse caring for a client experiencing withdrawal from a CNS depressant is aware that there is a nonpharmacologic treatment used during withdrawal from CNS depressants. Which is it? Select all that apply. a Recommending group therapy b Using activated charcoal to absorb the drug c Inducing vomiting d Taking vital signs every hour e Keeping the client awake
a,c,e Rationale During withdrawal from LSD, nonpharmacologic treatment includes speaking slowly and clearly to the client; ensuring low stimuli with minimal light, sound, and activity; and having one person reassure and open double quote"talk the client down.close double quote" Individual and group therapy would be beneficial after the withdrawal of the substance.
The nurse caring for a client experiencing withdrawal from the hallucinogen LSD is aware that there are nonpharmacologic treatments used during withdrawal of LSD, What are they? Select all that apply. a Speaking slowly and clearly to the client b Recommending group therapy c Having one person reassure and "talk the client down " d Recommending individual therapy e Ensuring low stimuli with minimal light, sound, and activity
d Rationale Psychoanalytical theory sees addiction as a fixation at the oral developmental stage. Behavioral theory sees addiction as learned maladaptive behavior. Family theory sees addiction as a result of multi-generational dysfunctional family patterns. Some personality theories see addiction as a result of psychological inadequacy.
The nurse educator is discussing psychological theories of addiction with a student. What statement indicates that the student understands these psychological theories? a "Personality theories see addiction as a result of negative reinforcement. b "Family theory sees addiction as learned maladaptive behavior. " c "Behavior theory sees addiction as a result of family dysfunction. " d "Psychoanalytical theory sees addiction as a fixation at the oral developmental stage.
d Rationale Dopamine and serotonin, both essential neurotransmitters, are involved in developing a dependence on alcohol. An excess of glutamate can result in brain damage and stroke. A deficiency of acetylcholine is believed to be one of the causes of Alzheimer disease. Gamma-aminobutyric acid (GABA) may play a role in facilitating sleep.
The nurse educator is discussing the chemistry of alcohol dependence with a group of students in the classroom environment. Which statement made by a student indicates correct understanding of the neurotransmitters involved in alcohol dependence? a "Excess glutamate creates a dependence on alcohol. b "A deficiency of acetylcholine creates a dependence on alcohol. c "Gamma-aminobutyric acid (GABA) is involved in alcohol dependence. d "Dopamine and serotonin are involved in developing a dependence on alcohol
b A combination of individual and group therapy has proven to promote behavior changes, teach new coping measures, and help move individuals to an addiction-free life. Individual therapy would provide an opportunity for Marcus to develop a trusting relationship with a nurse, but it alone would not provide enough support to change his behavior. Group therapy would provide an opportunity for shared experiences, but it alone would not provide enough support to change his behavior. Family therapy would provide an opportunity for family members and significant others to better understand Marcus's condition, but it would not change his environment. In addition, it might be ineffective in this instance because Marcus's brothers and girlfriend are also addicted to the drug. Next Question
The nurse is assessing Marcus Rusa, a 17-year-old boy addicted to methamphetamines. Marcus explains that it is difficult to stop using the substance because he is surrounded by it every day. Both of his brothers and his girlfriend are methamphetamine users. What type of nonpharmacologic treatment would allow Marcus to change his environment in order to address his addiction? a Family therapy b Combination of individual and group therapy c Individual therapy c Group therapy
b
The nurse is assessing Mr. Kelvin, a 35-year-old man who injured himself by punching and shattering a mirror. Despite having serious lacerations on his hands and arms, Mr. Kelvin is talkative and euphoric. He tells the nurse that he has not slept in two days. What substance use do Mr. Kelvin's symptoms suggest? a Opiates b Cocaine c Cannabis d Nicotine
b Rationale The lack of oxygen to the brain (anoxia) that results when opiates are used causes pupils to become dilated. A respiratory rate of 18 is within the normal range; in an overdose, as the client either goes into or is in a coma, respirations decrease to 6dash-8 rpm and eventually to possible respiratory arrest. The client, if conscious, will have incoherent and slurred speech, not coherent speech. The client with an overdose will be in shock, so the skin will be clammy and moist, not dry.
The nurse is assessing a client admitted to the hospital with an overdose of an unknown opiate. Which signs and symptoms would the nurse expect to assess? a Coherent answers to questions b Dilated pupils c Respiratory rate of 18 breaths per minute e Dry, intact skin
d The Subjective Opiate Withdrawal Scale (SOWS) determines the extent of physical dependence on opiates. The B-DAST screening tool is used for those clients addicted to alcohol. The UDS (urine drug screening) tests the amount of the substance in the body but does not determine physical dependence. The BRADEN tool is useful when assessing the risk of skin breakdown.
The nurse is caring for Mr. Sands, a 56-year-old man. During the admission assessment, he remarked that he is addicted to opiates. Which screening tool would the nurse use when trying to determine the extent of his physical dependence on opiates? a UDS b B-DAST c BRADEN d SOWS
c Rationale Nursing interventions for the client who abuses inhalants include reducing sensory stimuli; therefore dimming the lights would be a way to decrease stimuli. Turning on the television or playing music would increase rather than reduce sensory stimuli. Discussing the client's situation with family members would not be a useful nursing intervention for dealing with the agitation.
The nurse is caring for a client who has been abusing inhalants. The client becomes extremely agitated after a visit from family members. What nursing intervention could the nurse use to decrease the client's agitation? a Playing the client's favorite music b Discussing the situation with the family members c Dimming the lights d Turning on the television
a,c,e Rationale Pharmacologic treatment measures for cocaine abuse include antipsychotics, antidepressants, and dopamine agonists. Methadone and Narcan are pharmacologic treatment measures for opiate use, not cocaine use.
The nurse is caring for a client with a diagnosis of cocaine addiction. The nurse would anticipate the healthcare provider ordering which medications in the treatment of cocaine abuse? Select all that apply. a Antipsychotics b Narcan c Antidepressants d Methadone e Dopamine agonists
d Rationale Naltrexone (ReVia, Depade) blocks pathways to the brain that trigger the feeling of pleasure, reducing the craving for alcohol. Disulfiram (Antabuse) is a form of aversion therapy that prevents the breakdown of alcohol, causing the symptoms of physical illness in an individual who consumes alcohol while taking the medication. Metoprolol tartrate (Lopressor) is useful in treatment of esophageal varices if needed to reduce the risk of bleeding. Lorazepam (Ativan) is associated with minimizing discomfort and preventing such adverse outcomes as seizures.
The nurse is caring for a client with known alcohol abuse. The client states he would like to start medication for alcohol withdrawal, but he does not want the drug that makes him vomit. He has heard there is a medication that helps reduce the craving for alcohol and would prefer that one. The nurse recognizes the client is referring to which medication? a Disulfiram (Antabuse), an alcohol antagonist b Metoprolol tartrate (Lopressor), a beta-blocker c Lorazepam (Ativan), a benzodiazepine d Naltrexone (ReVia, Depade), an opioid analgesic
a
The nurse is caring for an adolescent client diagnosed with alcoholism. The client states he is frequently coerced by family to do things that cause feelings of unhappiness, such as turning over his entire paycheck or babysitting younger siblings. Which intervention might the nurse select to help the client develop new coping skills? a Assertiveness training b Thought stopping c Pain management d Mindfulness training
b Rationale The social microcosm concept postulates that members eventually behave in the therapeutic group the same way they behave with family and friends. Extinction involves the weakening of the undesirable behavior through the processes of conditioning. Splitting is a polarization of beliefs. Internalization is absorbing an idea or feeling into one's ego.
The nurse is conducting a support group for adolescent drug users. The nurse notes that one member is treating another member in the same critical way he treats his younger sister. Which group therapy concept does this observation demonstrate? a Splitting b Social microcosm c Extinction d Internalization
a,c,d Rationale Building trust, respecting confidentiality, and including family members in the assessment can help uncover hidden addiction problems. Accepting all explanations is not always useful in assessing substance abuse. Providing referrals is a nursing intervention, not an assessment activity.
The nurse is conducting an assessment interview with a client who may be abusing substances. Which elements are important for the nurse to incorporate in the interview, if family members are to be included? Select all that apply. a Building trust b Accepting all explanations c Respecting confidentiality d Including family members e Providing referrals
a,b,c
The nurse is preparing to screen a number of clients who abuse alcohol. Which risk factor might the nurse expect to find in these clients? Select all that apply. a Trauma exposure b Environmental hardships c Early onset of alcohol use d Higher level of education e Becoming a parent
c cold meds may contain alcohol
The nurse is providing discharge teaching for a client taking Naltrexone (Revia). The nurse should instruct the client to avoid which OTC? a. acetaminophen b. ibuprofen c. cold medicine d. antihistamines
a,c,d,e Rationale IV drug use may result in the transmission of certain infectious diseases, such as hepatitis B and C, and HIV/AIDS. Tuberculosis is not a bloodborne disease.
The nurse is providing education to a client who admits to IV drug use. The nurse will provide education on which infectious diseases based on the client's history of drug use? Select all that apply. a AIDS b Tuberculosis c HIV d Hepatitis B e Hepatitis C
a,b,c,e Rationale Clients who use and abuse substances often continue this practice even when it begins to interfere with family and interpersonal relationships; with work performance, attendance, and work relationships; and the completion of responsibilities both at home and at work. Cravings can be either physical or psychological, and craving increases, not decreases, as substance use progresses. When clients develop tolerance to a drug, they often use more of the drug than intended.
The nurse is reviewing with a new staff nurse the clinical signs exhibited by a client who is dependent on drugs. What clinical manifestations might the client exhibit? Select all that apply. a Using more of the drug than intended b Forgetting to complete an assigned task c Problems with work performance d Decreased craving for the drug e Interruption of a relationship with a significant other
a
The nurse is working in a clinic that conducts drug testing, and is aware that drug tests may be performed on which body parts or fluids? a Hair b Skin c Mucus d Teeth
a,b,c,d
The nurse is working with a client suffering from cocaine addiction. One intervention goal is to help the client develop more effective coping skills. What are some of the dysfunctional defenses typical of addicts that the nurse should help the client to address? Select all that apply. a Rationalization b Minimization c Projection d Denial e Sublimation
a,d,e
The nurse is working with a client with a history of substance abuse. Which client statements indicate that the client is in recovery? Select all that apply. a "I've been back in school for the last two semesters. " b "I don't think I really was addicted; I just went through a bad patch. " c "I still like hanging with my old friends. " d "I haven't used drugs in over two years. " e "I know I'll always have to work the program.
d
The nurse notes that a post op pt RR has dropped from 14 to 6 breaths per min. The nurse administers Narcan (naloxone) per standing order. Following administration of the medication, the nurse should assess the client for : a. pupillary changes b. projectile vomiting c. wheezing respirations d. sudden, intense pain
c
The nurse should be particularly alert for which one of the following problems in clients with barbituate overdose? a. oliguria b cardiac tamponade c apnea d hemorrhage
Ans: 3 Before someone enters an alcohol rehabilitation program, there should be a medically-supervised detoxification. This patient has walked in off the street; therefore, you must determine whether he is at risk for withdrawal symptoms. The other questions are relevant and are likely to be included in the interview. Focus: Prioritization
10. A patient comes into the walk-in clinic and tells you that he wants to be admitted to an alcohol rehabilitation program. Which question is the most important to ask? 1. "What made you decide to enter a program at this time?" 2. "How much alcohol do you usually consume in a day?" 3. "When was the last time you had a drink?" 4. "Have you been in a rehabilitation program before?"
b,c,d,e
The school nurse is conducting a class for high school students on substance abuse. When educating the students about the risk factors for becoming addicted to a substance, which would the nurse include? Select all that apply. a Family involvement b Family history c Depression d Low self-esteem e Peer pressure
a,b,e
The school nurse notices that the parents of two school-age children are not involved in their children's school activities. The children's maternal grandmother tells the nurse that the parents are recovering addicts. Which type of therapy might the nurse consider appropriate for this situation? Select all that apply. a Family therapy b Behavior therapy c Pharmacologic therapy d Occupational therapy e Group therapy
c
The student nurse is conducting an interview with a client admitted for methamphetamine abuse. The nursing instructor is observing the interaction between the student and the client. The nursing instructor should intervene when she hears the student ask which question? a "Which drug did you take before coming to the hospital? " b "On average, how many days per week do you use drugs? " c "Why would you use amphetamines, knowing what they do to you? " d "How often and how much do you usually use?
a,c,e Nursing interventions for clients with addictive behaviors include nursing care for any specific presenting symptoms; establishing a therapeutic relationship with appropriate boundaries; and promoting healthy client communication and coping skills. It is outside the scope of nursing practice to prescribe medications to a client. Providing care for presenting problem is a collaborative intervention between the primary health care provider and the nurse. The nurse can administer medications per order, but not prescribe them.
What are appropriate independent nursing interventions for a client diagnosed with an addiction? Select all that apply. a Teaching communication skills b Providing care for presenting problem c Promoting effective coping skills d Prescribing a medication for symptom management e Establishing a therapeutic relationship
b,c,d,e Rationale Inhalants can displace oxygen and cause tachycardia and respiratory depression. Assess for renal function because chemicals found in many glues can cause chronic renal damage. It is best to have a single nurse who talks to, calms, and reassures the client until the effects of the substance use subside. To calm the client, external stimuli should be reduced, with minimal sound, light, and activity. Naloxone (Narcan) is not effective with the use of inhalants.
What is the nurse's role during an overdose episode in a client being treated for glue inhalation? Select all that apply. a Administering naloxone (Narcan) 0.4 mg intravenously b Maintaining an accurate record of fluid intake and output c Assessing the client's heart rate, respirations, and blood pressure d Maintaining a quiet environment e Assigning the client to one nurse for therapeutic intervention
a
What is the purpose of disulfiram (Antabuse)? a To prevent the breakdown of alcohol, causing the symptoms of physical illness b To minimize discomfort c To block pathways to the brain that trigger the feeling of pleasure d To prevent seizures
a Phenobarbital is an anticonvulsant that controls seizures and acts as a sedative. Abstinence medications like Antabuse diminish cravings for alcohol. Thiamine and folic acid correct vitamin deficiencies. Antidepressants are used to stabilize mood and diminish anxiety.
What is the purpose of phenobarbital? a It controls seizures and acts as a sedative. b It diminishes cravings for alcohol. c It corrects vitamin deficiencies. d It diminishes anxiety and stabilizes mood.
a,c,d,e
Which are considered curative factors in group therapy? Select all that apply. a Universality b Individuation c Altruism d Existential factors e Group cohesiveness
b,c,d,e Rationale Cocaine users have symptoms of anxiety, talkativeness that indicates rambling thought processes, elation, euphoria, and sometimes tactile hallucinations. Cocaine users exhibit insomnia, not excessive sleeping.
Which cognitive signs and symptoms would the nurse expect to assess for a newly admitted client who is dependent on cocaine? Select all that apply. a States that he or she sleeps all the time b Expresses feelings of anxiety c Pulls at clothes while fidgeting in the chair d Appears overly happy in spite of the hospital admission e Talks incessantly with rambling thought patterns
a,c,d,e
Which considerations might interfere with a client revealing an addiction to a health care provider? Select all that apply. a Fear of legal reprisal b Nurse-client relationship c Shame d Contempt e Embarrassment
a The nurse would perform a focused assessment of the skin during the physical examination portion of the nursing assessment. A symptom questionnaire and a family interview would be conducted during the health history. A chest x-ray is a diagnostic tool and is not performed by the nurse.
Which data are collected during the physical examination of a client diagnosed with addiction? a Focused assessment of skin b Family interview c Chest x-ray d A symptom questionnaire
c
Which disorder is considered a process addiction? a Cocaine addiction b Alcoholism c Gambling addiction d Heroin addiction e Barbiturate addiction
c
Which factor does not contribute to an adolescent's risk of substance abuse? a History of trauma b Peer pressure c Intelligence level d Low self-esteem
a,b,d,e Nicotine addiction is associated with multiple health risks, including heart disease and premature aging. Many cancers, among them cancers of the lung, bladder, colon, and cervix, may be related to nicotine addiction. Recent studies have indicated a negative relationship between Kaposi sarcoma and nicotine use.
Which health risks are associated with nicotine addiction? Select all that apply. a Premature aging b Lung cancer c Kaposi sarcoma d Cervical cancer e Heart disease
a,b,d Obtaining samples for drug analysis; providing a quiet private room; and obtaining a drug history are all appropriate interventions to promote safety. Setting limits to behavior and encouraging the client to verbalize fears are appropriate interventions for promoting healthy coping skills.
Which intervention is appropriate for promoting safety? Select all that apply. a Obtain samples for drug analysis b Provide a quiet private room c Encourage the client to verbalize fears d Obtain a drug history e Set limits to behavior
a,d,e
Which is a risk factor for substance use disorders? Select all that apply. a Mental illness b Divorce c Family history d Low income e Loneliness
a All the choices are etiological factors, but when an individual's family and friends approve of the person's substance use, it is considered a sociocultural factor. The feelings of relaxation provided by substance use are psychological factors. A family history of alcohol abuse and the effects of cannabis, cocaine, and alcohol on dopamine levels are neurological factors.
Which is a sociocultural etiological factor affecting substance use disorders? a An individual's family approves of substance use. b Substances may provide feelings of relaxation. c Cannabis, cocaine, and alcohol increase dopamine levels. d The individual has a family history of alcohol abuse.
c
Which is an appropriate dose for methadone? a 4 mg/day b 400 mg/day c 40 mg/day d 0.4 mg/day
c,d The client admitting to a problem with substance abuse and the client describing choices made that contributed to substance abuse are both expected outcomes for a client diagnosed with increased risk of denial. These expected outcomes demonstrate the client's willingness and ability to recognize substance abuse as a problem. The client remained free of injury, the client verbalized the negative effects of alcohol on the body, and the client participated in group therapy are not expected outcomes for a diagnosis of increased risk of denial.
Which is an expected outcome for a client with a diagnosis of increased risk of denial? Select all that apply. a The client verbalized the negative effects of alcohol on the body. b The client participated in group therapy. c The client admitted having a problem with substance abuse. d The client described choices made that contributed to substance abuse. e The client remained free of injury.
a,c,d,e
Which is true regarding substance abuse in older adults? Select all that apply. a Alcohol and drugs can make it difficult to diagnose medical problems. b Substance abuse is more likely to be recognized in older adults. c Older women are more likely to use prescription medicines. d Depression and alcohol abuse are disorders frequently found in completed suicides. e Individuals can have substance abuse problems at any age
d
Which medication is commonly used in treatment programs for heroin abusers to produce a non euphoric state and to replace heroin use? A diazepam B carbamazepine C clonidine D methadone
c,d,e
Which nursing intervention should be implemented to promote safety for the client during alcohol withdrawal? Select all that apply. a Teaching the client healthy coping mechanisms b Encouraging the client to verbalize fears c Assessing the client's level of orientation frequently d Explaining all interventions before approaching the client e Using simple step-by-step instructions with the client
c all other options are for the RN
Which of the following is within the scope of the nursing assistant? a. obtaining vital signs following a craniotomy b. obtaining hourly I&O's of a pt with preeclampsia c. feeding a client with depression d. ambulating the client following a hip replacement
a Rationale Stimulants including cocaine cause vasoconstriction and can lead to serious cardiovascular complications, including tachycardia, arrhythmias, elevated blood pressure, and sudden cardiac death. Tachycardia and hypertension are cardiovascular symptoms due to vasoconstriction resulting from cocaine use. Blood pressure, heart rate, and pulse rate increase, not decrease, with cocaine use.
Which physical signs of cocaine abuse would the nurse expect to assess while the client is examined in the emergency department? a Elevated heart rate and hypertension b Increased pulse rate and hypotension c Decreased heart rate and hypertension d Decreased pulse rate and hypotension
d
Which psychological condition is one of the most prevalent precursors of substance abuse among adults aged 45 to 60? a Obsessive-compulsive disorder (OCD) b Borderline personality disorder c Schizophrenia d Depression
c
Which risk factor associated with alcohol abuse is considered a genetic influence? a Early onset of use b Environmental hardships c Drug sensitivity d Trauma exposure
d Rationale The CIWA-Ar is used to monitor and medicate clients going through alcohol withdrawal. The MAST indicates a potentially dangerous pattern of alcohol abuse. The CAGE questionnaire signifies that a client has a problem with alcohol and may require treatment. The B-DAST determines the severity of alcohol abuse.
Which screening tool is used to monitor and medicate clients going through alcohol withdrawal? a MAST b CAGE c B-DAST d CIWA-Ar
c,d,e
Which sign of alcohol withdrawal syndrome appears within 6 to 8 hours after the last drink? Select all that apply. a Hallucinations b Confusion c Increased anxiety d Irritability e Mild tachycardia
a
While interviewing a client with alcohol abuse, the nurse learns the client has experienced blackouts. The wife asks what this means. What is the nurses best response at this time? a your husband experiences short term memory amnesia b your husband has exeperienced loss of remote memory c you husband has experienced loss of conciousness d your husband has experienced a fainting spell
c
a client with a history of cocaine abuse is experiencing tactile hallucinations. This symptom is known as : a. dyskinesia b. confabulation c. formication d. dystonia
d
a client with acute alcohol intoxication is being treated for hypomagnesemia. During assessment of the client, the nurse would expect to find: a. bradycardia b. negative chvostek's sign c. hypertension d. positive trousseaus sign
d
a client with alcoholism has been instructed to increase his intake of thiamine The nurse know the client understands the instruction when he chooses which food? a roast beef b broiled fish c baked chicken d sliced pork
