Ch 58: Drug therapy for Substance Abuse Disorders

c) Seizures Pg. 1153 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.

1. Which of the following symptoms may be present during severe alcohol withdrawal? a) Hyperventilation b) Bradycardia c) Seizures d) Hypothermia

d) Using methadone maintenance may lead to a dependence on methadone Pg. 1158 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.

10. 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 has a short duration of action b) Methadone is an ineffective drug c) Methadone is expected to be soon banned in the United States d) Using methadone maintenance may lead to a dependence on methadone

d) Marijuana Pg. 1160 The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.

11. A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of a) Methamphetamine b) Cocaine c) Nicotine d) Marijuana

0.7 mL Pg. 1155 To calculate the quantity of medication, divide the dose desired by the dose available: 3.5 mg divided by 5 mg/mL = 0.7 mL.

12. 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?

a) Dopamine Pg. 1151 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.

13. Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine? a) Dopamine b) Epinephrine c) Acetylcholine d) Serotonin

c) Close monitoring and gradual tapering down of the dose Pg. 1159 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.

14. 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) Prompt discontinuation of the medication and liberal use of NSAIDs c) Close monitoring and gradual tapering down of the dose d) Education about how to use PRN naloxone in case of overdose

d) Cocaine Pg. 1160 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.

15. 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) Opioids b) Barbiturates c) Benzodiazepines d) Cocaine

c) PCP Pg. 1161 PCP is a hallucinogen. Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.

16. Which drug would be classified as a hallucinogen? a) Amyl nitrate b) Rohypnol c) PCP d) Heroin

d) Chlordiazepoxide Pg. 1153 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.

24. A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order? a) Bupropion b) Varenicline c) Cannabis d) Chlordiazepoxide

a) Type of substance being used b) Amount and frequency of use e) Method of administration Pg. 1151 The assessment interview should be directed toward identifying the type of substance the person has been using, the amount and frequency of use, the last time substance was used, the method of administration, and the length of time the substance has been abused. It is not important in the initial interview to elicit information on the first substance used or the length of time between uses.

17. The mental health nurse is conducting an assessment interview with a new client. What should this initial assessment be directed toward? (Mark all that apply.) a) Type of substance being used b) Amount and frequency of use c) What substance was first used d) Length of time between uses e) Method of administration

a) Disulfiram (Antabuse) Pg. 1157 Disulfiram (Antabuse) is a drug given to people recovering from alcoholism who cannot control the compulsion to drink. Ativan, Narcan, and Dolophine are not used as alcohol deterrents.

18. Which of the following medications are used as an alcohol deterrent? a) Disulfiram (Antabuse) b) Lorazepam (Ativan) c) Naloxone (Narcan) d) Methadone (Dolophine)

a) "Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes" Pg. 1160 Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.

19. A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide? a) "Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes" b) "Most people don't know that marijuana can be just as addictive as heroin or cocaine over time" c) "Marijuana can easily interact with other drugs and cause potentially fatal reactions" d) "Every year, thousands of Americans end up in emergency departments with marijuana overdoses"

b) Drug therapy could substitute one abused drug for another Pg. 1152 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.

2. 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 therapy is usually ineffective b) Drug therapy could substitute one abused drug for another c) The patient may not want to undergo drug therapy d) The wide range of antidotes makes selection of the appropriate treatment drug difficult

c) The medication is given for a short time to help the client complete the withdrawal process Pg. 1155 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.

20. 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 will help the client forget about the physical sensations that accompany alcohol withdrawal b) 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 d) The medication helps in the treatment of coexisting diseases, such as cardiac problems and hypertension

a) Rupture of the aorta Pg. 1160 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.

21. 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) Rupture of the aorta b) Renal ischemia c) Hepatotoxicity d) Nasal mucosal atrophy

c) "It involves feelings of satisfaction and pleasure from taking the drug" Pg. 1150 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.

22. 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 is the physiologic adaptation to chronic use of a drug" b) "It involves the unpleasant symptoms that result when you stop taking the drug" c) "It involves feelings of satisfaction and pleasure from taking the drug" d) "It is the decreased effect of the drug that occurs with extended use"

b) "Many studies say that certain genes can cause alcoholism" Pg. 1151 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.

23. 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) "Whatever the reason for your alcoholism, you need to quit drinking. It will kill you at this rate" b) "Many studies say that certain genes can cause alcoholism" c) "You are an alcoholic because you choose to drink" d) "There is no proof that alcoholism is hereditary"

d) "Doing that damages the brain and other body organs" Pg. 1161 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.

25. 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) "Let's talk about why you would want to sniff these substances" d) "Doing that damages the brain and other body organs"

a) Facilitating detoxification Pg. 1151 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.

26. 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) Facilitating detoxification b) Initiating a program aimed at long-term abstinence c) Mobilizing the client's support system d) Screening the client for addiction

d) This medication will eliminate cravings for alcohol Pg. 1157 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.

27. 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) A dose should be taken promptly if the client drinks alcohol c) The medication prevents the client from experiencing any effects of alcohol intake d) This medication will eliminate cravings for alcohol

a) Seizures Pg. 1151 A clinical manifestation of alcohol withdrawal include seizures. Tachycardia, hypertension, and diaphoresis are additional clinical manifestations.

28. Which of the following is a clinical manifestation of alcohol withdrawal? a) Seizures b) Hypotension c) Dry skin d) Bradycardia

b) Dextromethorphan Pg. 1160 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.

29. 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) Acetaminophen b) Dextromethorphan c) Ibuprofen d) Guaifenesin

d) Respiratory function Pg. 1153 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.

3. 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) Blood pressure and heart rate b) Motor function c) Neurologic assessment d) Respiratory function

a) They should be part of any treatment program for a drug-dependent person Pg. 1152 Psychological rehabilitation efforts should be part of any treatment program for a drug-dependent person.

30. 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 are rarely covered by health insurance c) They are successful when used in facility-based rehabilitation programs d) They do not make an impact on addiction treatment because it is a physical dependence

a) Avoid mixing disulfiram and alcohol Pg. 1157 The nurse should advise the client to avoid mixing disulfiram and alcohol because life-threatening cardiopulmonary complications and even death can occur.

4. Which of the following instructions should a nurse provide a client with alcohol dependence who is prescribed disulfiram? a) Avoid mixing disulfiram and alcohol b) Take in adequate fluids before medication c) Maintain bed rest for 1 hour after medication d) Avoid driving for 3 hours after medication

b) Brain Pg. 1160 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.

5. 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) Liver b) Brain c) Blood pressure d) Cardiovascular

a) Agitation b) Severe headache d) Facial flushing e) Blood pressure 100/62 mm Hg Pg. 1157 Combining ethanol with disulfiram results in varied unpleasant effects, including headache, flushing, and hypotension. The combination of these effects is likely to result in agitation and distress. Confusion may result, but the CNS is not depressed by this combination of effects, so drowsiness is atypical.

6. A client has been prescribed disulfiram for the treatment of alcohol abuse, in addition to psychosocial interventions. The client has now presented to the emergency department and admits to recently consuming several shots of whiskey. What assessment findings should the nurse anticipate? Select all that apply. a) Agitation b) Severe headache c) Decreased level of consciousness d) Facial flushing e) Blood pressure 100/62 mm Hg

a) Using the drug creates the feeling of satisfaction and pleasure Pg. 1150 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.

7. 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) Using the drug creates the feeling of satisfaction and pleasure b) Laboratory findings are congruent with frequent intoxication c) There is a need to increase frequency of medication usage to achieve desired effects d) Stopping the drug results in unpleasant symptoms

d) Sedation Pg. 1156 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.

8. 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) Increased thirst b) Anxiety c) Insomnia d) Sedation

b) Easy access Pg. 1150 Health care professionals (e.g., health care providers, pharmacists, nurses) are considered to be at high risk for development of substance abuse disorders, at least partly because of easy access.

9. Health care professionals are considered to be at high risk for development of substance abuse disorders, at least partly because of what factor? a) Knowledge of the risks involved b) Easy access c) Low cost d) Lax regulations related to use