Sem 3 - Unit 1 - Addiction - NCO

What does the term "smokeless tobacco" refer to? Select all that apply. 1 A substitute for cigarettes 2 Tobacco products that are safe for adolescents 3 Tobacco products that produce less smoke 4 Tobacco products with carcinogenic chemicals 5 Tobacco products placed in mouth but not ignited

1 A substitute for cigarettes 4 Tobacco products with carcinogenic chemicals \5 Tobacco products placed in mouth but not ignited "Smokeless tobacco" is the term used for tobacco products that are cigarette substitutes. These items are consumed by placing them in mouth, but they are not ignited. Smokeless tobacco contains carcinogenic agents that are not safe in adolescents. Tobacco products that produce less smoke are not considered smokeless.

Thiamine (vitamin B 1) and niacin (vitamin B 3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? 1 Neuronal activity 2 Bowel elimination 3 Efficient circulation 4 Prothrombin development

1 Neuronal activity Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacture of prothrombin.

Typical signs of neonatal abstinence syndrome related to opioid withdrawal usually begin within 24 hours after birth. What characteristics should the nurse anticipate in the infant of a suspected or known drug abuser? Select all that apply. 1 Tremors 2 Dehydration 3 Hyperactivity 4 Muscle hypotonicity 5 Prolonged sleep periods

1 Tremors 3 Hyperactivity Opioid dependence in the newborn is physiologic; as the drug is cleared from the body, signs of drug withdrawal become evident. Tremors and hyperactivity are typical signs of cerebral irritability. Dehydration is a result of inadequate feeding, not a direct result of opioid withdrawal. Muscle hypertonicity, not hypotonicity, occurs with opioid withdrawal. Signs of opioid withdrawal include excessive activity and sleep disturbances.

A nurse is caring for a client who has abruptly stopped taking a barbiturate. What withdrawal complication does the nurse anticipate that the client may experience? 1 Ataxia 2 Seizures 3 Diarrhea 4 Urticaria

2 Seizures Seizures are a serious side effect that may occur with abrupt withdrawal from barbiturates. Ataxia, diarrhea, and urticaria are not associated with barbiturate withdrawal.

A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine? 1 Risk for self-injury 2 Potential for seizure 3 Danger of dehydration 4 Probability of injuring others

Correct 1 Risk for self-injury The greatest risk in cocaine withdrawal is risk for self-injury. The risk for seizure is increased while a person is under the influence of cocaine, not during withdrawal. Although dehydration may occur during cocaine use and withdrawal, it is not the priority concern. People in cocaine withdrawal, although irritable, are more apt to hurt themselves than others.

A client is responding within 5 minutes of receiving naloxone to combat respiratory depression from an overdose of heroin. Why will a nurse continue to closely monitor this client's status? 1 The drug may cause peripheral neuropathy. 2 Naloxone and heroin can cause cardiac depression when combined. 3 Symptoms of the heroin overdose may return after the naloxone is metabolized. 4 Hyperexcitability and amnesia may cause the client to thrash about and become abusive.

3 Symptoms of the heroin overdose may return after the naloxone is metabolized. When naloxone is metabolized and its effects are diminished, the respiratory distress caused by the original drug overdose returns. A combination of these drugs does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.

A client tells the nurse, "All my friends experiment with drugs. I like the high I get when I huff paint. Nothing bad is going to happen to me." What is the best response by the nurse? 1 "Inhalants can cause a mild state of intoxication." 2 "Huffing paint can damage your lungs, kidneys, and liver." 3 "Withdrawal problems will start if you continue huffing paint." 4 "Limiting the type of inhalant used decreases respiratory irritation."

Correct 2 "Huffing paint can damage your lungs, kidneys, and liver." Inhaled toxins become systemic and cause damage to major organs such as the lungs, liver, and kidneys. Inhalants tend to produce euphoria, not just a mild state of intoxication. Huffing paint will not produce major withdrawal symptoms. All toxic substances that are inhaled become systemic and cause damage to major organs such as the lungs, liver, and kidneys.

A nurse is teaching a group of clients with peripheral vascular disease about a smoking cessation program. Which physiologic effect of nicotine should the nurse explain to the group? 1 Constriction of the superficial vessels dilates the deep vessels. 2 Constriction of the peripheral vessels increases the force of flow. 3 Dilation of the superficial vessels causes constriction of collateral circulation. 4 Dilation of the peripheral vessels causes reflex constriction of visceral vessels.

Correct 2 Constriction of the peripheral vessels increases the force of flow. Constriction of the peripheral blood vessels and the resulting increase in blood pressure impairs circulation and limits the amount of oxygen being delivered to body cells, particularly in the extremities. Nicotine constricts all peripheral vessels, not just superficial ones. Its primary action is vasoconstriction; it will not dilate deep vessels. Nicotine constricts rather than dilates peripheral vessels.

A nurse is caring for several clients who are going through withdrawal from alcohol. What is the primary reason for the ingestion of alcohol by clients with a history of alcohol abuse? 1 Are dependent on it 2 Lack the motivation to stop 3 Have no other coping mechanism 4 Enjoy the associated socialization

1 Are dependent on it Alcohol causes both physical and psychological dependence; the individual needs and depends on the alcohol to function. The theory that alcoholics have no other coping mechanism is a myth that often is associated with alcoholism; the individual needs to learn how to use other coping mechanisms more consistently and effectively. People with alcoholism commonly drink alone or feel alone in a crowd.

A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. 1 Stillbirth 2 Ebstein anomaly 3 Neural tube defects 4 Spontaneous abortion 5 Intellectual disabilities

1 Stillbirth 4 Spontaneous abortion 5 Intellectual disabilities Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.

What is a priority nursing intervention in the care of a drug-dependent mother and infant? 1 Supporting the mother's positive responses toward her infant 2 Requesting that family members share responsibility for infant care 3 Keeping the infant separated from the mother until the mother is drug free 4 Helping the mother understand that the infant's problems are a result of her drug intake

1 Supporting the mother's positive responses toward her infant A nurse should attempt to support the mother-child relationship; the mother is experiencing a developmental crisis while coping with drug addiction and possibly guilt. It is the client's right to decide who will share in the care of her child. The client needs contact with her new infant to facilitate bonding. Helping the mother understand that the infant's problems are a result of her drug intake will make the client feel guilty and will not facilitate positive action at this point.

A nurse is counseling a client who abuses cocaine. The nurse recognizes that this drug is representative of which drug category? 1 An opioid 2 A stimulant 3 A barbiturate 4 A hallucinogen

2 A stimulant Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with the amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis.

A 20-year-old carpenter falls from a roof and sustains fractures of the right femur and left tibia. The client reveals a history of substance abuse. What is the primary consideration for the nurse who is caring for this client? 1 Confronting the client about substance abuse 2 Avoiding calling attention to the client's drug abuse 3 Determining the amount and time of last use of the substance 4 Realizing that this client will need more pain medication than a nonabuser

3 Determining the amount and time of last use of the substance Determining the amount and last use of the substance is the priority. Nurses should base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not the nurse's responsibility at this time. The client must be helped to recognize that a problem with drugs exists, but this is not the priority. Because of cross-tolerance the client may need larger doses of analgesia for pain relief than a nonabuser would, but this is not the priority.

A 45-year-old client who recently completed alcohol detoxification reports plans to begin using disulfiram (Antabuse) as part of the alcoholism treatment regimen. What important client teaching does the nurse share regarding this drug? 1 Voluntary compliance with the disulfiram regimen is very high. 2 A single dose of oral disulfiram will be effective for up to 72 hours. 3 Disulfiram may be taken intramuscularly and will be effective for as long as 7 days. 4 Foods, medications, and any topical preparation containing alcohol should be avoided.

4 Foods, medications, and any topical preparation containing alcohol should be avoided. Disulfiram causes unpleasant physical effects when mixed with alcohol. Any substance that contains alcohol may trigger an adverse reaction. Voluntary compliance with the use of disulfiram is often very low because of the negative physical effects experienced by the individual if alcohol is ingested. For disulfiram to be effective, it must be taken orally every day. Disulfiram is not administered intramuscularly.

What is the planned effect of naloxone when it is administered for a heroin overdose? 1 To compete with opioids for occupancy of opioid receptors 2 To prevent excessive withdrawal symptoms as heroin wears off 3 To accelerate metabolism of heroin and stimulate respiratory centers 4 To stimulate cortical sites that control consciousness and cardiovascular function

1 To compete with opioids for occupancy of opioid receptors Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this drug. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.

A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing what phenomenon? 1 Tolerance 2 Habituation 3 Physical addiction 4 Psychological dependence

1 Tolerance Tolerance is a phenomenon that occurs in addicted individuals in which increasing amounts of the drug of addiction are needed to satisfy need; the client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.

After a client on the mental health unit with a known history of opioid addiction has a visit from several friends, a nurse finds the client in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion? 1 Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min 2 Blood pressure of 180/100 mm Hg, tachycardia, and respiratory rate of 18 breaths/min 3 Blood pressure of 120/80 mm Hg, regular pulse, and respiratory rate of 20 breaths/min 4 Blood pressure of 140/90 mm Hg, irregular pulse, and respiratory rate of 28 breaths/min

Correct 1 Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Opioids cause central nervous system depression, resulting in severe respiratory depression, hypotension, tachycardia, and unconsciousness. The other findings, particularly the respirations, are not indicative of an overdose of an opioid.

A client who is a polysubstance abuser is mandated to seek drug and alcohol counseling. What is an appropriate initial outcome criterion for this client? 1 Verbalizes that a substance abuse problem exists 2 Discusses the effect of drug use on self and others 3 Explores the use of substances and problematic behaviors 4 Expresses negative feelings about the current life situation

Correct 1 Verbalizes that a substance abuse problem exists The client must first acknowledge that a substance abuse problem exists and is creating chaos; verbalizing that a problem exists indicates that the client is not in denial and is taking the first step toward change. Once a problem is identified, the numerous ways in which drug use has controlled the client's life and the resulting lifestyle problems can be explored, and the nurse can help the client express and process negative feelings.

A nurse is planning care for a client with substance-induced persisting dementia resulting from long-term alcohol use. Which nutritional problem, in addition to the effect of alcohol on brain tissue, has contributed to substance-induced persisting dementia? 1 Increase in serotonin 2 Deficiency of thiamine 3 Reduction in iron intake 4 Malabsorption of riboflavin

Correct 2 Deficiency of thiamine Substance-induced persistent dementia is caused by a prolonged deficiency of vitamin B1 (thiamine) and the direct toxic effect of alcohol on brain tissue. Increase in serotonin, reduction in iron intake, and malabsorption of riboflavin are problems that are unrelated to substance-induced persisting dementia caused by alcoholism.