Substance Related & Addictive Disorders Ch.19 Psych Exam2
A nurse is teaching a group of clients about addiction. One client says he can stop drinking whenever he wants. The nurse concludes that this client does not yet understand that addiction is a disease in which individuals primarily lose ability to do which of the following? 1. Control addictive and impulsive behaviors 2. Recognize that addictive behavior is harmful to self and others 3. Act sober even if they are not 4. Think logically about their addictive behaviors
Answer: 1 Rationale: Controlling addictive and impulsive behaviors is correct. The key symptoms addiction is impaired control, or the inability to control, or regulate, one's addictive behavior. While individuals with addiction do not change their behavior b/c of negative consequences sustained (recognizing that addictive behavior is harmful), it is not that they do not recognize the consequences. Rather, they continue the addictive behavior in spite of consequences experienced. Acting sober when intoxicated is an addictive behavior. In addition to loss of control, the individual with addiction is not able to view the addictive behaviors realistically or logically. The individual frequently uses the defense mechanisms of denial, rationalization, and projection.
A client staggers when walking into the day treatment center with an intense odor of alcohol and insists that he has not consumed any alcohol. The nurse concludes that this behavior constitutes which of the following? 1. Denial 2. Rationalization 3. Transference 4. Countertransference
Answer: 1 Rationale: Denial is correct. It would not be unusual for a client who has severe addiction to come to day treatment intoxicated and deny it. Denial would cause a client to insist he/she his not intoxicated, or doesn't have a problem with alcoholism, despite concrete evidence of the problem. Rationalization is a frequently used defense mechanism of the individual with alcoholism, but it is were being used, the client would offer an explanation for the odor of the alcohol (such as, "I spilled a bottle of cologne as I was getting dressed"). Transference is the unconscious process of displacing feelings for significant people in the past onto the nurse in the present relationship. Countertransference is the nurse's emotional reaction to clients based on feelings for significant people in the nurse's past.
Which skill training should the nurse plan for a group of adolescent clients diagnosed with alcoholism in order to assist them in a relapse prevention program? 1. Critical-thinking skills 2. Drinking-refusal skills 3. Problem-solving skills 4. Communication skills
Answer: 2 Rationale: The quality of an adolescent's recovery environment can be helpful or hurtful to someone attempting to maintain sobriety. Friends or acquaintances may encourage a recovering individual to use, so drink-refusal skills are important to learn. The recovering adolescent may want to refuse but not know how. Behavioral rehearsal, such as saying "no thanks" to an offer to engage in addictive behavior, can increase a recovering individual's confidence. Critical thinking skills will not help the adolescent to refuse a drink. Problem-solving skills are generally useful but are not specific to drink refusal. Communication skills are generally useful but not as helpful as skills directly r/t refusing to drink.
Which statement should the nurse include when teaching the client about the drug disulfiram? 1. "Inhaling fumes from paints and wood stains may cause a disulfiram reaction." 2. "Eating inadequately cooked seafood may lead to disulfiram resistance." 3. "Taking disulfiram will reduce your physical craving for alcohol." 4. "If you consume alcohol while taking disulfiram, rapid intoxication will occur."
Answer: 1 Rationale: Stating that "inhaling fumes from paints and wood stains may cause a disulfiram reaction" is correct. The adverse reaction of disulfiram will occur if the individual taking this drug ingests, inhales or absorbs alcohol, even in very small doses (such as inhaling vapors from paints or wood stains, or oral ingestion in products such as mouthwash). These reactions include throbbing headache, tachycardia, diaphoresis, and respiratory distress. Death can occur. This drug is not used often, but the nurse should know about its uses and dangers. While eating improperly cooked seafood might lead to gastric distress or liver problems, uncooked seafood does not precipitate disulfiram reaction. Disulfiram does not reduce the craving for alcohol, but opioid antagonists, such as naltrexone, do. Disulfiram works on the classic principle of conditioned avoidance. If the individual drinks alcohol while taking disulfiram, intently unpleasant and dangerous physical reactions can occur. The effect of disulfiram when combined with alcohol is not intoxication. Instead, the individual experiences intensely dangerous and unpleasant reactions.
What info would the student nurse include in report about the 12-step program of Alcoholic Anonymous (AA)? Select all that apply. 1. People learn to change negative attitudes and behaviors into positive ones. 2. Once an individual learns how to be sober, he or she can graduate from attending meetings. 3. Once an individual has achieved sobriety, he or she continues to be at risk for relapse into drinking. 4. Acceptance of being an alcoholic will prevent urges to drink, since it represents giving up one's denial. 5. A higher power will protect individuals if they feel like using.
Answer: 1, 3 Rationale: AA teaches that a client with alcoholism can never safely return to social drinking and that total abstinence is the only course in treating addiction. People learn how to develop positive attitudes and behaviors to replace negative ones. When sobriety has been achieved, people don't "graduate"; they stay and help others achieve sobriety. Acceptance and higher power are active concepts in AA, but practicing these principals does not remove urges to drink and does not guarantee sobriety.
A nurse is working with a client detoxifying from alcohol who exhibits coarse hand tremors and diaphoresis. What should be the priority interventions by the nurse? Select all that apply. 1. Assess level of consciousness 2. Explain the concepts of withdrawal to the client 3. Administer prescribed thiamine and folic acid 4. Determine the most recent blood alcohol level 5. Assess vital signs
Answer: 1, 5 Rationale: Assessing the client's LOC is of high priority in monitoring a client experiencing withdrawal as part of withdrawal management. The nurse should assess viral signs to recognize possible signs of autonomic hyperactivity that is a part of alcohol withdrawal delirium. The nurse should be able to recognize and respond to the clinical signs of increasing intensity of withdrawal symptoms. Because the client is in active withdrawal, this is not the time to teach the client (explaining the concepts of withdrawal). The priority is on maintaining physiological functioning and environmental safety. Thiamine and folic acid may be prescribed for the client who is withdrawing from alcohol, but they are used to treat complications of alcoholism, not to manage the acute symptoms of withdrawal. This can only be done with a drug that is cross-tolerant with alcohol. Determining the most recent blood alcohol level is inappropriate, as it would not provide current data.
The nurse should conclude that a nursing in-service was effective when one of the nurses says that the most influential risk for impaired nursing practice is which of the following? 1. Having grown up in a dysfunctional family 2. Feeling that nurses' knowledge about drugs protects them from drug dependency 3. Thinking that professionals are not at high risk for substance dependency 4. Having a tendency to involve self in codependent professional and personal relationships
Answer: 2 Rationale: Feeling that nurse's knowledge about drugs protects them from drug dependency is correct. The most significant risk factors that lead nurses to abuse drugs and to become drug dependent, are exposure to substances, knowledge about specific effects of certain drugs, and belief that knowledge about drugs will allow them to use drugs and alcohol safely. Some nurses have grown up in a dysfunctional family, but this does not put them more at risk than those in the general public who have similar backgrounds. Most nurses know that healthcare providers and professionals are at a high risk for drug dependency, but they deny that this could happen to them, b/c they feel protected by their knowledge about drugs. Some nurses may have problems with codependence, but this does not put them at more risk than those in the general public who have similar problems.
What is the best response by the nurse to client who is being treated at an addiction center who questions why his 13 yr old son needs to participate in family sessions, since he has not seen his father drinking? 1. "Your son probably knows that you are an alcoholic." 2. "Your son has probably seen changes in you when you were drinking." 3. "It's good that you have concern for your underage son." 4. "13-year-olds are old enough to start learning about the effects of alcohol."
Answer: 2 Rationale: Stating that the son has probably seen changes in the client in a matter-of-fact, informative way. It creates an opportunity for the nurse to help the client see that the parent-child relationship has no doubt been impacted by the addiction. Stating that the son probably knows the client is an alcoholic applies a label to the client (an alcoholic), although the information it is conveying is accurate. Telling the client it's good that he has concern for his son offers approval or praise, and it allows the client to feel like a protective and good parent, instead of a parent whose behavior has impacted negatively on the son. Stating that the son is old enough to learn about the effects of alcohol removes the personal focus that is necessary to help the parent who is addicted recognize the impact of the addiction on the son.
The nurse determines that a client diagnosed with addiction understands the information provided about addiction when the client makes which statements? Select all that apply. 1. "Addiction is a moral problem." 2. "Addiction is a medical illness." 3. "Addiction is a behavioral habit." 4. "Addiction is an emotional attachment." 5. "Addiction is difficult to cure."
Answer: 2, 3, 4 Rationale: Three options are correct. Alcoholism was officially listed as a disease in 1956, and Jellinek's identification of the 4 phases of disease progression in 1960 reinforced the disease concept ("addiction is a mental illness"). Addictions includes behavioral habits and emotional attachment, but it is seen first as a medical disease. Although alcoholism has been recognized as a disease for approx. 50 years, many members of the general public continue to view addiction as a moral weakness. Addiction experts do not consider that addiction can be cured. Instead they consider is a chronic medical disease that can be managed.
Which question asked by the nurse would be consistent with the structure of CAGE? Select all that apply. 1. "Have you ever counted the number of drinks consumed?" 2. "Have you ever felt that you needed to cut down on your drinking?" 3. "Have you ever been annoyed by comments made about your drinking?" 4. "Have you ever found yourself gulping drinks before going out?" 5. "Have you ever had a morning 'eye-opener' to calm your nerves?"
Answer: 2, 3, 5 Rationale: Feeling a need to cut down on drinking indicates the "C": cutting down or reducing alcohol. Annoyance represents the "A": being annoyed at what others say about drinking. As for having a morning "eye-opener," the "E" is when the client needs a drink in the morning or upon awakening. The "C" is the CAGE mnemonic represents cutting down, not counting. The "G" in the CAGE mnemonic represents guilt, not gulping drinks
Which drug should the nurse recognize is most likely to lead to significant physical, cognitive, and developmental problems for any infant? 1. Benzodiazepine 2. Hallucinogen 3. Alcohol 4. Cocaine
Answer: 3 Rationale: Alcohol use during pregnancy causes dysmorphic prenatal and postnatal difficulties and CNS dysfunction. These problems range from subtle cognitive and behavioral impairments to fetal alcohol syndrome, both of which predispose the infant to later academic and behavioral problems, as well as mental illness. Since alcohol is so widely used many people do not recognize its dangers, as they either do not consider it a drug or think that it is a safe drug. The use of benzodiazepines, hallucinogens, and cocaine can cause significant health problems for the infant, but these problems are not as pervasive as those associated with the mother's using alcohol during pregnancy.
A client is seeking information about the detoxification process and withdrawal from a benzodiazepine drug. How should the nurse describe the detoxification process? 1. Rapid reduction in amount and frequency of the drug 2. Abrupt discontinuation of the drug 3. Gradual downward reduction in dosage of drug commonly used 4. Planned, progressive addition of an antipsychotic drug
Answer: 3 Rationale: Gradual reduction in dosage of the drug commonly used is correct. Medically supervised withdrawal from benzodiazepines generally involves a gradual downward titration of doses of the drug commonly used. Rapid discontinuation of benzodiazepines is physiologically dangerous. Most antipsychotics lower the seizure threshold and are, therefore, not appropriate for clients in active benzodiazepine withdrawal, b/c they would increase the risk for seizure activity.
A nurse has explained the use of naltrexone to a client. The nurse should interpret that teaching was effective when the client identifies which purpose of naltrexone? 1. Prevent withdrawal symptoms 2. Reduce number of blackouts 3. Reduce craving for alcohol 4. Manage heightened anxiety
Answer: 3 Rationale: Naltrexone is a narcotic antagonist that is useful for treating individuals that have alcohol dependence with high levels of craving and somatic symptoms. It works by blocking opiate receptors and reducing or eliminating the alcohol craving. Naltrexone does not prevent withdrawal symptoms. Since it is a narcotic antagonist, and narcotics and alcohol are both CNS depressants, it is possible that naltrexone could precipitate withdrawal symptoms in an individual who has had recent intake of alcohol. Naltrexone is not expected to prevent or reduce alcoholic blackouts or to directly manage anxiety.
A client says, "I have a very small drink every morning to calm my nerves and stop my hands from trembling." The nurse should conclude that this client is describing which state? 1. An anxiety disorder 2. Tolerance 3. Withdrawal 4. Alcohol abuse
Answer: 3 Rationale: Taking a drink in the morning to steady one's nerves is a sign of physical dependence and is done to avoid withdrawal symptoms. Tremors are one of the ten symptoms of alcohol withdrawal listed in the Clinical Institute Withdrawal Assessment of alcohol symptoms. People with anxiety may have tremors, but the tremors would occur throughout the day. Tolerance is not indicated b/c the client does not describe needing to have a larger drink in order to prevent symptoms. This client has clearly progressed from alcohol abuse to alcohol dependency.
Which of the following is the most likely treatment sequence for a client recovering from alcohol abuse who tells the nurse that she is very depressed and has a hard time staying sober? 1. Depression before the sobriety issue 2. Sobriety issue before the depression 3. Sobriety issue and depression at the same time 4. Depression after the sobriety issue has been resolved
Answer: 3 Rationale: The sobriety issue and depression are treated at the same time. This client will likely be dually diagnosed with alcoholism and depression. The nurse should recognize that current standard of addiction practice call for the substance abuse disorder and the psychiatric disorder to be treated simultaneously. Depression would not be treated before the sobriety issue. The sobriety issue would not be treated before the depression. Treatment for depression would not be delayed until the sobriety issue has been resolved, b/c addiction is not a problem that is "resolved."
What alcoholic phenomenon should the nurse recognize when a client who has a blood alcohol level (BAL) of 0.35% is walking without stumbling and is talking rationally about the client's head injury following a motor vehicle accident? 1. Alcohol withdrawal syndrome 2. Intolerance 3. Psychological dependence 4. Alcohol dependency
Answer: 4 Rationale: Alcohol dependency is correct. As a blood level of 0.35%, the non-physically-dependent, non-tolerant drinker would be confused, ataxic, and either semi-comatose or comatose. Death is expected when the BAL reaches aprrox 0.50%. The situation suggests that this client has been drinking regularly over a long period of time and is now experiencing tolerance of alcohol (needing an increasing amount of alcohol to bring about the desired effect). There is no evidence of withdrawal s/s, such as anxiety, tremulousness, and marked elevation in VS. Tolerance can only develop once the individual is physically dependent on alcohol. This clients is not acutely intoxicated, even though the BAL exceeds the normal level of intoxication (0.08% to 0.10%). This client's body now accepts unusually high concentrations of alcohol (tolerance) and has adapted to the presence of alcohol (physical dependence). No information is given that would allow recognition of psychological dependence which can come very early in drinking history and precede physical dependence and tolerance.
What would be an appropriate nursing concern for client with a hx of substance abuse whose admitted to hospital for chest pain? 1. Altered family processes due to alcoholism 2. Inability to manage therapeutic regimen 3. Potential for injury 4. Difficulties with decision making ........
Answer: 4 Rationale: Difficulty in decision-making, which can lead to pronounced anxiety & possible chest pain, can occur when there is uncertainty about a course of action or difficulty choosing among competing actions that involve risk, loss, or challenge to personal life values. Altered family processes due to alcoholism may apply, but is more appropriate for the family than for the individual. Inability to manage the therapeutic regimen implies that the client has already made a commitment to recovery. Since the client probably abuses or is dependent on alcohol, a potential for injury may be present, but there is no specific info in the question to suggest this.
A client with a long history of relapsing from cocaine dependence states that, despite wanting to be sober, the client continues to have thoughts reusing cocaine. The nurse decides to educate the client about the role the brain reward system (BRS) plays in addiction. The nurse should evaluate the teaching as effective if the client makes which statement about the BRS? 1. "The BRS reinforces the value of positive role models." 2. "The BRS offers a means of mediating job stress and pressure." 3. "The BRS reduces physiologic and psychological cravings." 4. "The BRS facilitates cravings and triggers for reusing."
Answer: 4 Rationale: Facilitating cravings and triggers for reusing is correct. Cravings appear to be the result of pleasurable memories engendered from the psycho-activating effects of engaging in addictive behaviors. Substance of abuse alter the brain's reward system by artificially boosting dopamine effects, which keep the pleasure circuit firing. It's true that environment and role models influence patterns of use, but this is not part of the BRS phenomenon. As for offering a means of mediating job stress and pressure, it is true that people employ addictive behaviors to self-medicate stress and pressure experienced, but this is not part of the BRS phenomenon. Reducing physiologic and psychological cravings indicates that the BRS is a positive phenomenon that assists with drug abstinence. Instead, the BRS is a negative phenomenon that assist with maintaining or returning to the substance use patter.
What should be the most important nursing intervention when caring for a client experiencing delirium tremens? 1. Present psychoeducation on dangers of drug and alcohol use 2. Encourage the client to develop a relapse prevention plan 3. Administer anti-craving medications 4. Provide withdrawal care based on unit protocol
Answer: 4 Rationale: Providing withdrawal care based on unit protocol is correct. Alcohol withdrawal delirium (delirium tremens, or DTs) is physiologically dangerous process with potentially fatal consequences. Various medical approaches are used to treat it, and the nurse's care must fit into the protocol of the clinical agency. Priority is assigned to the client's physical needs during this major withdrawal phenomenon. Beginning education about the disease (presenting psychoeducation) and encouraging development of a relapse prevention plan are not appropriate at this time, b.c the client is in physiological peril. These options can be appropriate after the withdrawal period has ended. Administrating anti-craving medications is not the highest current priority, as the client is actively withdrawing from alcohol and be be at risk physiologically.
A client who has alcohol dependence & cardiomyopathy tells the nurse that she is certain that her family & friends are against her. The client goes on to say, "They stay on my back about my drinking & say I could die from it." What is the best response by the nurse? 1. "Anyone saying this to you must have a problem with his or her own drinking." 2. "Although their intentions are good, they have no right to judge another person's drinking." 3. "Do you think they may be jealous that you can drink more than they can?" 4. "Perhaps they have noticed that your drinking creates consequences for you."
Answer: 4 Rationale: Suggesting that the family and friends have noticed that her drinking creates consequences is correct. It indicates one of the areas of the CAGE questionnaire that deals with expressed concern from others about client's drinking. It is inappropriate to assume that those speaking to the client have drinking problems. This statement could support the client's projection of the drinking problem. Stating others have no right to judge the client labels those individuals as judgmental and diminishes their concern for the client. Asking about others' motives of jealousy is non therapeutic and judgmental.