HESI - Psych. Addiction, Chemical, Dependency & Withdrawal
A 72-year-old man shows signs of alcohol abuse. Which statement indicates the nurse needs more education about substance use? A. "I don't need to administer the CAGE-AID screening tool because the patient says he consumes only four alcoholic drinks at one time." B. "The alcohol in the drinks the patient consumed will be metabolized slowly." C. "If the patient drinks only a small amount of alcohol, he will be affected by it." D. "Because of decreased total body fluid, my patient's blood alcohol level will increase more rapidly than it would in a younger patient."
A. "I don't need to administer the CAGE-AID screening tool because the patient says he consumes only four alcoholic drinks at one time." Rationale: The nurse needs more education about assessment with the CAGE-AID tool, which is appropriate for a 72-year-old patient who has four alcoholic drinks at a time. Hazardous drinking for older adults (generally 65 years of age and older) is defined as consuming three or more alcoholic drinks in one sitting or seven or more alcoholic drinks in 1 week. Because of a decrease in total body fluid, the blood alcohol level in an older adult increases more rapidly, and alcohol is metabolized more slowly. Even a small amount of alcohol can have a dramatic effect on an older adult.
A nurse is caring for a patient with a history of alcohol and sedative-hypnotic dependence. What is the most important outcome in this situation? A. The patient is free of seizures. B. The patient reports decreased craving. C. The patient attends a support group. D. The patient is admitted for rehabilitation.
A. The patient is free of seizures. Rationale: Alcohol and sedative-hypnotic withdrawal can result in seizures, which can threaten the patient's life. Decreased craving, addiction support group attendance, and rehabilitation are all essential, but the patient's safety and the prevention of seizures take precedence.
A patient arrives at the emergency department reporting lower back pain. During the nursing assessment, the patient reports taking large amounts of opioids for pain with no relief. What is the patient most likely doing? A. The patient may be seeking buprenorphine or methadone for pain relief. B. The patient may be downplaying the use of the opioids. C. The patient may be experiencing opioid withdrawal. D. The patient may be experiencing cocaine withdrawal.
A. The patient may be seeking buprenorphine or methadone for pain relief. Rationale: Some patients with untreated or inadequately treated pain may exaggerate (not minimize) their use of opioids to acquire methadone or buprenorphine to alleviate their discomfort. Opioid withdrawal symptoms include muscle aches, and withdrawal from cocaine typically manifests as dysphoria.
The patient presents to the emergency department after sustaining injuries in a fight. When asked about alcohol use, the patient admits to drinking on a daily basis. A new nurse asks the supervisor why monitoring this patient closely is important, considering that he is not drinking now. What is the supervisor's best response to the new nurse? A. "The practitioner has placed the order to monitor the patient closely." B. "Alcohol withdrawal is a potentially life-threatening condition." C. "He may try to leave to go get a drink, so you should watch him closely." D. "In the emergency department, our standard routine is to monitor all new patients closely."
B. "Alcohol withdrawal is a potentially life-threatening condition." Rationale: Alcohol withdrawal symptoms can appear within 12 to 24 hours after drinking and, if not properly treated, can develop into a life-threatening situation for the patient. Although a practitioner may order the close monitoring, the health care team must understand why. The patient may attempt to leave, and patients in the emergency department do receive careful monitoring, but these are not the primary reasons for the close monitoring required for this patient.
A patient is admitted with a history of alcohol dependence. During assessment, the nurse learns that the patient has had withdrawal seizures in the past. What should the nurse do to keep the patient safe? A. Administer the CAGE-AID screening tool. B. Implement falls protocols. C. Assess the patient's vital signs. D. Draw a specimen for a blood alcohol level.
B. Implement falls protocols. Rationale: Patients who experience significant alcohol withdrawal may have withdrawal seizures. Implementing fall protocols decreases the possibility of injury. The CAGE-AID screening tool is not the appropriate step at this time, though it could be later. Assessing the patient's vital signs and drawing blood to determine blood alcohol level are significant steps that would have been part of the patient assessment but would not keep the patient safe in the event of a seizure.
The son of an older adult patient escorts her to the hospital after a serious fall in her home. He asks the nurse why his mother has been periodically confused and having episodes of poor balance and slurred speech. When asked about possible drug or alcohol use, he says: "That isn't possible; I've never seen her drink too much and she's too old to drink now anyway." What is the best response the nurse can provide? A. "You're correct; alcohol use is not an issue for older adults." B. "I have to ask these questions about every patient as part of our routine." C. "Alcohol abuse affects all ages, including older adults." D. "Even if she used alcohol, it would be metabolized quickly because she's an older adult."
C. "Alcohol abuse affects all ages, including older adults." Rationale: Alcohol abuse affects all ages. Older adults metabolize alcohol slowly, thus experiencing the effects for a longer period of time. Ingestion of even small amounts of alcohol affects older adults. Saying that questions are just routine and have to be asked is inappropriate.
A 15-year-old patient is being treated in the emergency department for injuries she sustained in a car crash. Her speech is slurred, and the nurse smells alcohol on her breath. When the parents arrive and are asked about the patient's alcohol use, they state that she could not have been drinking because when they asked her, she told them that she does not drink alcohol. What is the best response that the nurse can provide? A. "Maybe someone gave her alcohol without her knowledge, because you would certainly know if she drinks." B. "She's probably telling the truth because it would be unusual for a 15 year old to be drinking alcohol. C. "Alcohol is commonly used by people 12 to 20 years old, and for them to deny or minimize their drinking is not unusual." D. "You must not be adequately supervising your daughter because this would not happen if you were more responsible."
C. "Alcohol is commonly used by people 12 to 20 years old, and for them to deny or minimize their drinking is not unusual." Rationale: Use of alcohol is common among people aged 12 to 20 years, even though alcohol use is illegal for part of this age group, and many underage drinkers are treated in emergency departments. In addition, the three most common defense mechanisms in addiction are denial, rationalization, and minimization. Just because an adolescent says he or she does not drink does not always mean that he or she is telling the truth, and nor do parents always know if their child is drinking alcohol. Finally, blaming the parents or stating that their daughter would not drink alcohol if they adequately supervised her is neither helpful nor appropriate.
A 15-year-old patient is being treated in the emergency department for injuries he sustained in a car crash. His speech is slurred, and the nurse smells alcohol on his breath. Why should the nurse determine how much alcohol this adolescent used before the car crash? A. Alcohol use in people of this age is illegal. B. The patient may be at risk for developing diabetes. C. Binge drinking is common among adolescents and can lead to death by alcohol poisoning. D. The patient may have engaged in unplanned and unprotected sexual activity before coming to the emergency department.
C. Binge drinking is common among adolescents and can lead to death by alcohol poisoning Rationale: The nurse should assess alcohol intake because if the patient engaged in binge drinking, a risk of alcohol poisoning exists. Binge drinking is a common pattern among adolescents. The potential of this patient developing diabetes or contracting a sexually transmitted infection is not the nurse's immediate concern. Though alcohol use in this age group is illegal, the legality of the patient's actions is not the nurse's primary focus.
A patient has slurred speech and is disoriented. The nurse suspects that the patient has abused alcohol. What is the FIRST action that the nurse should take? A. The nurse should obtain a specimen for a urine drug screen. B. The nurse should obtain a specimen for a blood alcohol level. C. The nurse should take the patient's vital signs. D. The nurse should administer the CAGE-AID screening tool.
C. The nurse should take the patient's vital signs. Rationale: Taking a patient's vital signs early in assessment can help detect a risk of organ damage. If alcohol overuse is not treated, hypertension, hyperventilation, and tachycardia can occur during withdrawal. Taking the patient's vital signs is a priority nursing action over obtaining specimens for a blood alcohol level or urine drug screen. The CAGE-AID screening tool is useful for long-term patient assessment but is not a priority at admission.
A patient comes to the emergency department reporting flu-like symptoms. The nurse's assessment reveals diaphoresis, a runny nose, muscle aches, abdominal cramping, and diarrhea. The patient has a history of inpatient drug rehabilitation. What may these symptoms indicate if flu is ruled out as a cause of the symptoms? A. Cocaine withdrawal B. Sedative-hypnotic withdrawal C. Alcohol withdrawal D. Opioid withdrawal
D. Opioid withdrawal Rationale: Discontinuing opioid use leads to physical withdrawal, which can include early signs (muscle aches, runny nose, and sweating) and late signs (abdominal cramping and diarrhea). Alcohol and sedative-hypnotic withdrawal typically includes tremors, nausea, vomiting, and a rapid heart rate and has the potential to cause seizures. Cocaine withdrawal manifests as agitated and restless behavior, increased appetite, and dysphoria.
