Chapter 19: Addiction
The nurse is teaching a client about addiction. Which client statement indicates the education has been effective?
"A tolerance is built up over time, so more is needed to get the same effect."
The nurse is caring for a client who consumes an excessive amount of alcohol. The client abruptly stopped drinking at 1300 today. What is the latest time the nurse expects the onset of delirium tremens?
0100, tomorrow
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
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
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.
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
The nurse is caring for a client who is prescribed disulfiram prior to being discharged from an inpatient treatment facility. Which teaching statement will the nurse prioritize?
Check ingredients of all beauty products you use.
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
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?
Dopamine
The nurse is talking with a client that grew up in a home where both parents were alcoholics. Which behavior(s) does the nurse identify when assessing this client that correlate with this home life?
Drinks alcohol to excess 3 days a week. Divorced 3 times with tumultuous relationships with spouses. States that they hold on to bad relationships due to fear of being alone
A client has a history of consuming alcohol almost daily while pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol?
Fetal alcohol syndrome
When a client is working toward the prevention of alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?
Helping the client identify positive coping mechanisms
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
A 30yo client has been brought to the emergency department by EMS with an apparent heroin overdose. In the immediate care of this client, what assessments should the nurse prioritize?
Neurological and respiratory assessments
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
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
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?
Users of marijuana always experience relaxation and euphoria
A client is experiencing alcohol withdrawal symptoms. Which will the nurse expect to be prescribed to assist with the withdrawal symptoms, acting as a substitute for the alcohol?
benzodiazepines
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?
clordiazepoxide
A nurse is caring for a client with an acute substance intoxication. The client's pupils are dilated and the nurse notes the client's blood pressure is 166/108mmHg. Which substance is the most likely cause of the client's symptoms?
cocaine
The nurse is caring for a client with chronic alcohol use disorder that is experiencing an alteration in memory function. Which laboratory result will the nurse correlate with this assessment finding?
decreased thiamine level
The nurse is caring for an adult client that has been admitted to the detoxification unit. Due to acute withdrawal, what cues will the nurse likely assess?
flushed face, headache, and tremors
Ecstasy is an example of which type of substance?
hallucinogen
The nurse is caring for a group of clients. Which client does the nurse recognize as being most at risk for developing a substance use disorder?
teenage client with a mood disorder
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 is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks a 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 with a history of alcohol use disorder is participating in a 12-step Alcoholics Anonymous (AA) program. A nurse determines that the client is at step 2 based on what statement by the client?
"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, a nurse determines that the education was successful when the client makes which statement?
"I should eat small frequent meals if I get nauseated."
The nurse is teaching a client admitted with acute alcohol withdrawal about medications used to prevent complications during the withdrawal from alcohol. The nurse recognizes that teaching has been effective when the client makes which statement?
"I will be given a benzodiapine over several days as a substitution for alcohol."
The nurse is interviewing family members of a client being treated for substance use disorder. Which statement by a family member would alert the nurse to the possibility of codependency?
"My sibling would not drink as much if their spouse was more understanding."
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?
8
The nurse is caring for a client with alcohol use disorder that is acutely intoxicated. Which action will the nurse perform to treat the Wernicke-Korsakoff syndrome the client is experiencing?
Administer Vitamin B1
The nurse is caring for a client experiencing alcohol withdrawal. Which intervention will the nurse perform to alleviate the physical effects associated with alcohol withdrawal?
Administer fixed-dose chlordiazepoxide as prescribed.
The client is brought to the emergency room with opioid overdose. After the initial assessment for central nervous system (CNS) function, what will be the nurse's priority action?
Administer naloxone
The recommended first-line pharmacologic agents for managing sever alcohol withdrawal symptoms are in which class of medications?
Benzodiazepines
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.
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 client has been using heroin for 5 years and is attending narcotics anonymous meetings. Which statement by the client indicates the client is in the denial state of their addiction?
I can quit anytime I want. I don't even get high from the drug anymore.
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
Which statements identify positive aspects of methadone as a substitute for heroin?
It is a legal medication, controlled by a health care provider, and available in tablet form.
The nurse is talking with a client regarding their addiction to opioids. The client states, "I am unhappy in my job. My spouse is always nagging at me to make more money. The kids want more expensive toys." Which is the most therapeutic response by the nurse?
Let's talk about your behaviors and how you are responsible for your addiction.
Which medication is used to prevent alcohol withdrawal symptoms?
Lorazepam (ativan)
A client is experiencing severe alcohol withdrawal. Which would the nurse identify during the assessment that correlates with the withdrawal symptoms?
Marked diaphoresis, auditory hallucinations, gross uncontrollable tremors.
A client with a long history of alcohol abuse is hospitalized. The client's last drink was at noon. The nurse would anticipate symptoms of withdrawal beginning no later than what time?
Midnight
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.
A client with a history of alcohol use disorder has presented to the emergency department with hallucinations and relays being followed by the police. Which action will the nurse take given this information?
Monitor for Korsakoff syndrome from long-term effects of alcohol use
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
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
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
The nurse is caring for a client with a substance use disorder. When speaking with the client's spouse, the nurse finds the family member hides the client's disorder from others and helps cover for the client when the client is hungover. Which statement is true?
The spouse is acting in a codependent manner.
Which of the following would be used as nutritional supplementation for a patient during alcohol detoxification?
Thiamin, folic acid, magnesium sulfate
A client with chronic alcoholism has been found to have Wernicke encephalopathy. This irreversible complication is characterized by what?
Thiamine, or vitamin B1, deficiency
The nurse is assessing a client who is suspected of having an alcohol use disorder. The nurse asks about daily alcohol intake. The client replies, "The important point is that if I have 10 drinks, I don't get drunk." The nurse determines the client's response as what?
This is an indication of long term use of alcohol for this client.
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. How will the nurse document the assessment data?
Tolerance has developed with the alcohol use.
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
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?
A nurse observes a fellow nurse colleague who has an unsteady gait and slurred speech. The nurse suspects that the colleague is impaired. Which would be the appropriate action to take?
report the nurse colleague's behavior to the supervisor on the floor