Ch 19 - prepu addiction
Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which situation?
Having several clients complain that their pain medication is not working
A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?
Monday morning
Which drug reverses opioid toxicity?
Naloxone
A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when stating what?
"I realize that there is a higher power that can help me."
A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states what?
"I should eat small frequent meals if I get nauseated."
A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?
"It can help to prevent you from drinking."
A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?
"What negative consequences have resulted from your drinking?"
The nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?
"Your parent's alcohol use problem is a chronic disease but can be treated."
The nurse is providing care to a client who has abused alcohol for several years and is monitoring the client for signs of alcohol withdrawal, anticipating that they would begin within how many hours after the client has the last drink?
12
In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?
12 hours
A client with a long history of alcohol abuse is hospitalized. The client's last drink was 12 noon. The nurse would anticipate symptoms of withdrawal occurring no later than what time?
12 midnight
People addicted to alcohol and drugs have a rate of suicide that is what percentage higher than that of the general population?
15
Approximately what percentage of U.S. adults have substance use disorders?
22%
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?
8 Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.
Wernicke's encephalopathy is a degenerative brain disorder characterized by which type of deficiency?
Thiamine
When assessing a client diagnosed with chronic alcoholism, the nurse addresses potential memory dysfunction by reviewing the client's serum level of what?
Thiamine
The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase?
Adolescents
A nurse is conducting a seminar with a local parent group about substance use and abuse. The nurse determines that the seminar was successful when the group identifies which substance as the most abused in the United States?
Alcohol
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse?
All the conditions are attributable to the alcohol abuse
The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?
Asians
According to the psychodynamic theory regarding addiction, it is most important that the nurse assesses the client with an alcohol use disorder by considering what?
Asking the client to describe the client's childhood relationship with the client's parents
Disulfiram has been prescribed for a client receiving treatment for alcoholism. Which should be included in the client's plan of care?
Avoid all products containing alcohol
Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?
Benzodiazepines
Which is used as a first-line treatment for alcohol withdrawal?
Benzodiazepines
The mental health nurse should focus on preventative efforts including educational interventions related to the abuse of prescription drugs on which client group?
Both genders between the age of 12 and 17
A client with chronic alcoholism has been found to have Korsakoff's psychosis. This irreversible complication is characterized by what?
Thiamine, or vitamin B1, deficiency
While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?
CIWA-Ar
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?
Chlordiazepoxide
A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?
Delirium tremens
Clonidine is most effective for which symptom of opioid withdrawal?
Diarrhea Clonidine is most effective against nausea, vomiting, and diarrhea but produces modest relief from muscle aches, anxiety, and restlessness.
Which is an example of a benzodiazepine?
Diazepam
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?
Dopamine
A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?
Elevated temperature
A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class?
Hallucinogen
A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?
Hallucinogen
Ecstasy is an example of which type of substance?
Hallucinogen
The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?
Help them to identify appropriate diversional activities.
When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?
Helping the client identify positive coping mechanisms
A 47-year-old client has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, the client admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?
Imbalanced nutrition: less than body requirements related to chronic alcohol intake
When discussing methadone treatment with a client, the nurse should include what?
It decreases the severity of heroin withdrawal symptoms.
An older adult client with liver disease is experiencing alcohol withdrawal. Based on the nurse's understanding of drug therapy, which of the following would the nurse expect to be prescribed?
Lorazepam Antianxiety and sedating drugs, such as benzodiazepines, are titrated downwardly over several days as a substitution for the alcohol. Chlordiazepoxide (Librium) and diazepam (Valium) have longer half-lives and smoother tapers. Lorazepam (Ativan) is better for the older adult and people with liver impairment. Fluoxetine is not used.
Which medication is used to prevent alcohol withdrawal symptoms?
Lorazepam (Ativan)
After a long history of intravenous heroin use, a client has expressed willingness to stop using heroin. The nurse would expect the client to receive which medication to decrease the severity of withdrawal?
Methadone
A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?
Naloxone
A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which action?
Negotiating a conversation with the client about the need to change
A 30-year-old client has been brought to the emergency department by emergency medical services with an apparent heroin overdose. In the immediate care of this client, what assessments should the nurse prioritize?
Neurological and respiratory assessments
Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions?
Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered
A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which about the drug?
Reduces the appeal of alcohol
A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6º above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?
Risk for injury
A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?
Short history of drug use
A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with the therapist, the nurse states the nurse is nervous about how coworkers will respond to the nurse now that "they all know I'm a drunk." Which diagnosis best targets the problem implicit in the nurse's remarks?
Situational low self-esteem related to medical condition
A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?
Substance abuse disorders
Which statement most accurately describes the etiology of substance-related disorders?
Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors.
The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?
Tactile hallucinations
The nurse is counseling a group of clients recovering from substance abuse about the nature of denial. Which intervention should the nurse teach the clients to use to help them gain insight into their denial?
Teach them to question why they feel threatened.
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?
The client had six drinks a few hours ago.
The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?
The client most likely has a dual diagnosis since she has both a substance dependence and depression.
A nurse is assessing a client with bizzare and aggressive behavior in the emergency department. Upon questioning, the client's partner discloses that the client had been smoking PCP. While in the emergency department, the client continues to exhibit signs of PCP-induced psychosis and has required physical restraints. What nursing outcome should the nurse prioritize in the care of this client?
The client will be physically safe and without injury.
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?
The drug helps to satisfy the craving for the opioid.
A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?
The spouse will refrain from the enabling the client's drinking behaviors.
A client drinks 24 oz. of vodka every day, having gradually increased to this level over the past 2 to 3 years. The client continues to maintain a job and functions well in activities of daily living, relationships, and other aspects of social life. Which term should the nurse use to describe this drinking behavior?
Tolerance
Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?
Tolerance break
Which statement about clients with a dual diagnosis is accurate?
Traditional methods of treatment have not been very successful for these clients.
A nurse is conducting a class for a group of high school students about marijuana use and abuse. The nurse determines that the class needs further discussion when they state which of the following?
Use of marijuana does not lead to addiction.
An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?
Verbalize feeling safe and comfortable.
High doses of alcohol produce which effect?
Vomiting
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?
Wernicke-Korsakoff syndrome