Chapter 71: Caring for Clients with Chemical Dependence

A nurse is instructing a client who is to receive disulfiram. Which statement by the client demonstrates that the teaching was effective?

"I can use any antacids."

The family of a client withdrawing from heroin asks a nurse why the client is receiving naltrexone. Which response is correct?

"It's used to help reverse withdrawal symptoms."

A client is trying to stop smoking and reports concern to the nurse about gaining weight as a result. Which response from the nurse is most appropriate?

"Typically, clients gain 5 to 10 lbs in the first year after smoking cessation."

A nurse is teaching a group of smokers about the associated risks of tobacco use. The nurse explains that these clients are how many times more likely to develop peripheral vascular disease than nonsmokers? Fill in the blank with a number.

10

A client has been taking disulfiram and is about to stop. The nurse advises the client to avoid all forms of alcohol, including in substances like cough syrup, for a minimum of how many weeks after discontinuation of disulfiram? Fill in the blank with the correct number.

2

An alcoholic client has been consuming excessive amounts of cola and chocolate. The health care provider advises against disproportionate use of over-the-counter preparations containing caffeine. What should the nurse tell the client about the effect of caffeine in the body?

Adds to the depressive effect of alcohol

A client is being treated for alcoholism. Which organization can be recommended to assist the family in coping with this disease?

Al-Anon

Which instructions should a nurse provide to a client with alcohol dependence before administering the prescribed thiamine?

Avoid glucose solutions.

A nurse is developing strategies to prevent relapse with a client who abuses alcohol. Which client intervention is important?

Avoiding people, places, and activities from the former lifestyle

A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?

BP: 170/98, P:110, R: 20

Which statement about the pathophysiology related to substance abuse and chemical dependence is correct?

Central nervous system depressants are chemical agents that slow brain and physiologic activity. Stimulants such as caffeine, nicotine, cocaine, and amphetamines affect levels of norepinephrine, dopamine, and acetylcholine. Depressant drugs such as alcohol, heroin, and other opiates and barbiturates cause effects similar to those of gamma-aminobutyric acid, endorphins, and enkephalins.

A client is admitted to the alcohol rehabilitation program. What medication will the client be prescribed to treat alcohol withdrawal syndromes?

Chlordiazepoxide (Librium)

A client who has suffered bilateral fractures of the femurs in a fall undergoes a bilateral open reduction and internal fixation, and is admitted after recovering in the PACU. Twenty-four hours after admission, the client begins having hallucinations, agitation, hypertension, and profuse sweating. What would be the nurse's first step?

Consult with the physician regarding the need for a detoxification drug.

The nurse is assessing laboratory data of a client who has been complaining of gastric distress. The nurse is aware that which abnormal laboratory value may indicate that the client's gastric issues are related to chronic alcohol ingestion?

Elevated aspartate aminotransferase (AST)

The psychiatric community nurse is working with a highly culturally diverse group of mostly young adult clients who have substance abuse issues. Many clients have had difficult social circumstances and experience relapses. What would be the most appropriate nursing intervention in dealing with these clients?

Encourage motivation and confidence so that the clients can better deal with the triggers that cause them to repeat their behaviors.

A nurse is teaching a community class about the patterns of substance abuse. Place the patterns that the nurse would review in the correct sequence, from least to greatest severity.

Experimentation Habituation Dependence Addiction

A client consumed alcohol almost daily while she was 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

A 52-year-old client arrives at the emergency department via ambulance. The paramedics tell the nurse that the client drinks approximately 26 ounces of liquor per day and is suffering from alcohol withdrawal delirium. His last drink was 48 hours ago. Which symptoms would alert the nurse to the potential for delirium tremens?

Fever, hypertension, changes in level of consciousness, and hallucinations.

The nurse is speaking with a group of newly-recovering alcoholics and drug users in an outpatient rehabilitation program. Which of the following issues should the nurse raise before the clients leave for the day?

Help them to identify appropriate diversional activities.

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. For which of the following will the nurse assess?

Hypertension

A 47-year-old male has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, he 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 teaches what?

It decreases the severity of heroin withdrawal symptoms.

A client has come to the clinic with a fever and sore throat. This is his first visit in 18 months. The nurse notices that the client has acne, lesions, and scratch marks. Additionally, the client's teeth are broken, rotting, and discolored; the client's chart shows no indication of any previous tooth problems. He also weighs 20 lbs less than at his last appointment. What type of addiction would the nurse suspect may be apparent in this client?

Methamphetamine

Within 8 hours of her last drink, a client with alcoholism experiences tremors, loss of appetite, and disordered thinking. The nurse believes this client is in withdrawal. What should the nurse do next?

Obtain a physician's order for lorazepam (Ativan).

A client is admitted to an inpatient facility to be treated for his addiction problem. What is the role of the nurse with this diagnosis? Select all that apply.

Provide support during withdrawal. Assess physical condition and signs of toxicity. All choices are correct. Monitor for suicidal ideation. Administer medications. Assess the client's history of drug abuse.

A client is admitted to the emergency room suffering from symptoms of alcohol withdrawal. What symptom of withdrawal is the priority to prevent?

Seizures

A patient is admitted to the emergency room suffering from symptoms of alcohol withdrawal. What symptom of withdrawal is the priority to prevent?

Seizures

Which statement most accurately describes the etiology of substance-related disorders?

Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors.

Which of the following factors 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 client is now experiencing acute alcohol withdrawal. What complication should the nurse anticipate based on the present condition?

The increased potential for seizures and hallucinations.

A family expresses concern when a family member withdrawing from alcohol is given lorazepam. What information should be given to the family about the medication?

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

A client with alcoholism is showing cognitive changes consistent with dementia. The nurse is aware that what nutritional deficiency may be contributing to the client's problems?

Thiamine

A client drinks 24 oz of vodka every day and has been gradually increasing to this level over the past 2 to 3 years. The client continues to maintain a job and function in activities of daily living, relationships, and other aspects. Which of the following terms should the nurse use to describe the client's drinking behavior?

Tolerance

The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:

Underestimate the amount consumed

A client comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The client agrees to take disulfiram. The nurse will teach the patient that the combination of alcohol and disulfiram will cause which of the following?

Vomiting

Which treatment is not used to manage opiate dependence?

antabuse

What crimes have substance abuse as a major contributor?

assault domestic violence vehicular fatalities

A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies:

drug tolerance.

Which condition is not a consequence of smoking?

gynecological cancer

Which of the following is used as a substitute for heroin in some maintenance programs?

methadone

A client is receiving treatment for opioid toxicity. Which drug reverses opioid toxicity?

naloxone (narcan)

What is the definition of dependence?

need for a substance to avoid withdrawal symptoms

Nicotine, a legal substance that results in dependence, presents a major challenge to the health care industry. Annually, 438,000 people die to a tobacco-related complication. Which occurrence presents a similar mortality rate?

none

There are four steps toward the development of chemical dependence. Which term does not represent one of the steps?

tolerance

A patient is taking disulfiram and begins drinking a beer. What effect will be produced from the combination of alcohol and disulfiram?

vomitting