nicotine use dynamic study

The school nurse gives a presentation on tobacco use and prevention to a group of students. Which student statement indicates an understanding of the prevention information?

"Adolescence appears to be the primary time in which individuals initiate the use of tobacco." Individuals primarily initiate the use of tobacco during adolescence, not childhood, young adulthood, or middle age. Adolescents are thrill seekers. Due to developmental changes they act impulsively, often not recognizing that their risky behaviors have consequences.

A high school nurse is teaching a group of teenagers on common factors that may influence an individual to smoke. Which student statement indicates the need for further teaching?

"Age has nothing to do with someone choosing to smoke." Alcohol use, social pressure, lack of education, and age are all common factors that may influence an individual to smoke. Therefore, the statement "Age has nothing to do with it" would indicate a need for additional health teaching.

The patient is preparing to leave the smoking cessation class. Which statement by a participant indicates the need for further teaching?

"I can go out with my friends who smoke, but I will leave my cigarettes at home."

A patient shares his fear with the nurse that if he quits smoking he will gain weight. Which response made by the nurse is best?

"Let's talk about some other coping techniques like chewing sugar-free gum, rather than eating, when you crave a cigarette."

The nurse is assessing a patient with a nicotine addiction who has tried multiple times to quit. Which question by the nurse is least therapeutic?

"Smoking is bad for your health. Do you want to quit smoking?"

The nurse educator is preparing a presentation on the pathophysiology of nicotine use. Which receptors in the central nervous system (CNS) should the nurse identify that nicotine can occupy?

Acetylcholine

A homeless patient presents with unkempt hair, dirty fingernails, dry and cracked lips, extreme thirst, and clothing that has what appear to be burn holes. Which observation indicates to the nurse that this patient is a smoker?

Burn holes in clothing

Which clinical manifestation of nicotine addiction requires immediate intervention by the nurse?

Chest pain Chest pain is a clinical manifestation of nicotine addiction that requires immediate intervention. COPD, chronic hypercapnia, and a chronic cough do not require immediate intervention by the nurse.

The nurse is teaching patients who wish to quit smoking tobacco. Which benefit of smoking cessation should the nurse include?

Increase in energy

The nurse is caring for a patient who smokes and has a pressure ulcer on their lower leg. The nurse suggests that smoking should be stopped immediately. Which nutrient should the nurse suggest that the patient take to help wound healing?

Protein

Some of the most common factors that influence people to smoke are

emotions, social pressure, alcohol use, lack of education, and age.

The nurse performs a survey on smoking habits of older adults patients in an assistive living residence. Which is an expected outcome of such a survey?

Almost half of the patients smoked at one time, but less than 10% smoke now. A 2012 survey of Medicare recipients found that 8.8% were current smokers; 44.7% and 46.5% of the sample, respectively, were former and never smokers. Current smokers had lower socioeconomic status, were more socially isolated (and thus not married), and had higher depressive symptoms than older adults who never smoked. Because older adults with nicotine abuse issues may have smoked for a long period of time, counseling may need to be added to nicotine replacement therapy (NRT) for effective treatment.

The nurse is preparing a lesson on the pathophysiology of nicotine addiction. Which substances should the nurse state are released when nicotine stimulates nicotinic receptors?

Dopamine and norepinephrine In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine (a precursor to norepinephrine) and norepinephrine, causing vasoconstriction. The release of the neurotransmitters serotonin and acetylcholine is not stimulated by nicotine.

Young people are more likely to use tobacco if they have access to smoking areas and tobacco products, especially to low-cost or free tobacco. They are also more likely to use tobacco if they have:

Friends, brothers, or sisters who use tobacco. Watch movies that have smoking in them. Are not doing well in school or have friends who are not doing well in school. Are not engaged in school or religious activities. Use other substances, such as alcohol or marijuana.

The community nurse wants to decrease smoking in the community. Which factor has encouraged cigarette smoking?

Having actors smoke on television shows

The nurse is conducting a physical examination for a patient with a nicotine addiction. Which clinical manifestation should the nurse expect to find that is related to the effects of nicotinic receptors?

Hypertension

The nurse prepares a smoking cessation program at a local community center. Which type of addiction treatment is the nurse likely to exclude from the program presentation?

Medication therapy, behavior therapy, and support groups are common interventions for smoking cessation and are appropriate to include in the program presentation. Family therapy is not a typical method for smoking cessation. Therefore, this should not be included in the presentation.

Reference Range(s) Nicotine Cotinine

Nicotine Smokers 2-10 ng/mL Nonsmokers ≤4 nanogram/mL Cotinine Smokers 16-145 ng/mL Nonsmokers ≤8 nanogram/mL

The nurse is teaching a patient addicted to nicotine about pharmacologic treatments. Which treatment should the nurse suggest?

Nicotine gum

The nurse is caring for a patient who reports that ever since they started on the new medication to help them quit smoking, their throat feels irritated. Which nicotine replacement therapy (NRT) should the nurse suspect the patient has been using?

Nicotine spray Nicotine spray is an aerosol spray for the nose. Excessive use can cause irritation to the nose and throat. A nicotine patch is worn on the skin and does not cause throat irritation. Nicotine gum is not known to cause throat irritation. Oral lorazepam (Ativan) is not a form of NRT and is also not known to cause throat irritation.

A child whose father is trying to stop smoking by using nicotine gum presents with abdominal cramps, nausea, vomiting, chest pain, difficulty breathing, and rapid heart rate. Which serum test should the nurse expect the healthcare provider to order?

Nicotine/cotinine

The nurse is discouraged that despite teaching numerous smoking cessation classes, only about one in four patients is able to quit smoking while treated with nicotine replacement therapy (NRT). Which is the best course of action for the nurse?

Recognize this is the national average and continue to educate the public, pairing NRT with counseling

The nurse's role regarding smoking is to:

Serve as a role model by not smoking. Provide educational information regarding the dangers of smoking. Help make smoking socially unacceptable (for example, by posting no-smoking signs in patient lounges and offices). Suggest resources such as hypnosis, lifestyle training, and behavior modification to patients who want to stop smoking.

The school nurse is deciding on the target audience for a smoking cessation presentation. Which population should the nurse select?

Students whose parents smoke

While getting ready to take her new baby home, the patient states, "I cannot wait for a smoke." Which response by the nurse is appropriate?

"Smoking near your baby can cause significant harm to the baby. Let me share some information with you." The patient needs to be educated that smoking near the baby can cause sudden infant death syndrome (SIDS), otitis media, and asthma and other respiratory conditions. While it is good that the mother may have stopped smoking during the pregnancy, she should be encouraged to draw on those same coping skills to stop smoking altogether. The nurse has no knowledge of and has not witnessed the mother smoking near the baby and should not make accusatory and threatening statements.

During the health teaching session for patients addicted to nicotine, a participant asks about ways to prevent fingernails and fingers from turning yellow. Which response by the nurse is appropriate?

"Stop smoking."

The nurse is caring for a prenatal patient who has smoked for the past 12 years and is having difficulty quitting. Which is an appropriate statement by the nurse?

"There is medication therapy you may want to speak to your doctor about."

The nurse is assessing a patient for nicotine use. Which question is least therapeutic for the nurse to ask?

"What caused you to start smoking initially?" It is not useful to determine why the patient started smoking in an assessment, but rather the nurse should ask how ready the patient is to make a change and whether the patient has considered the costs and issues related to the addiction.