Substance-Related and Addictive Disorders

In confidence, an emergency department nurse said to a nursing colleague, "I know I am addicted to narcotics but I'm afraid I will lose my nursing license if I talk to my supervisor about it." Select the colleague's best initial response. "For the safety of your patients, you cannot use narcotics anymore. I hope you will get help." "I am glad you were willing to tell me about this problem. Narcotics Anonymous can help you." "There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." "There are many careers where you can use your nursing knowledge but not actually practice nursing. I will be glad to help you find one."

"There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." The colleague should first provide information about programming to give hope to the addicted nurse. Approximately 10% to 15% of nurses have problems related to abuse or addiction. For nurses who are engaging in risk-taking behaviors, there are nonpunitive alternatives to discipline programs in the form of peer assistance. Diversion legislation allows addicted nurses to attend a treatment or recovery program, have their progress monitored, meet specific criteria to return to work, and be spared revocation or suspension of their licenses if they follow the recommendations of their program. After responding, the colleague has a legal responsibility to report this information. p. 423

What is the nurse's most important intervention when caring for a patient experiencing severe alcohol withdrawal symptoms? Administer prescribed appetite stimulants. Administer prescribed hypnotic medication. Administer prescribed antipyretic medication. Administer prescribed anticonvulsant medication.

Administer prescribed anticonvulsant medication. The patient experiencing severe symptoms of alcohol withdrawal will experience generalized seizures, which are managed by administration of prescribed anticonvulsant medication. It is the most important nursing intervention in patients with severe alcohol withdrawal symptoms. Prescribed hypnotic medications are administered to treat insomnia, which is a mild symptom of alcohol withdrawal. Anorexia is also a mild symptom of alcohol withdrawal and can be managed with suitable appetite stimulants. Patients with severe alcohol withdrawal symptoms may experience a high-grade fever, generally above 101° F. The nurse should administer the prescribed antipyretic to reduce the fever. However, it is not the most important intervention. p. 420

The nurse is planning care management for a patient with alcohol misuse. What intervention does the nurse plan for rehabilitation of this patient? Avoid repeated counseling. Develop motivation and self-help skills. Refrain from assessing alcohol consumption. Avoid discussing the effects of alcohol intake.

Develop motivation and self-help skills. The patient needs assistance with motivation, support, and self-help skills to instill hope and positivity. Repeated counseling, follow-ups, or specialty referrals should be planned as required. Alcohol consumption should be assessed using a brief screening tool. The patient should be clearly advised about the effects of alcohol consumption. p. 425

Prescription of which medication represents part of an aversive therapy approach to treatment of addiction? Disulfiram Naltrexone Quetiapine fumarate Acamprosate calcium

Disulfiram When taking disulfiram, an individual who ingests alcohol will experience a toxic reaction that causes intense nausea and vomiting, headache, sweating, flushed skin, respiratory difficulties, and confusion. These symptoms are intended to create an aversion to use of alcohol. Quetiapine fumarate, acamprosate calcium, and naltrexone are medications prescribed to reduce discomfort associated with withdrawal. p. 425, Table 22.6

A nurse is assessing a patient, who has been withdrawing from cocaine. Which clinical findings of cocaine withdrawal does the nurse observe? Fatigue Depression Increased energy Poor concentration Decreased appetite

Fatigue Depression Poor concentration Cocaine is a stimulant, and its withdrawal may cause symptoms opposite to the stimulant effect. These include fatigue, depression, and poor concentration. Cocaine overdose may cause increased energy and decreased appetite as a result of its stimulant effect. p. 418

An adult has been abusing amphetamines. As this person withdraws, which assessment finding is most likely? Dilated pupils Irregular heart rate Excessive motor activity Psychomotor retardation

Psychomotor retardation Withdrawal from amphetamines commonly is associated with symptoms of depression. Psychomotor retardation commonly accompanies depression. Dilation of the pupils, dryness of the oronasal cavity, irregular heart rate, and excessive motor activity are symptoms of amphetamine intoxication. p. 418, Box 22.2

Which type of facility would best support the needs of an impaired patient who is need of long-term help related to hallucinogen abuse? Halfway house Partial hospitalization Intensive outpatient program Residential rehabilitation center

Residential rehabilitation center A patient with severe impairment as a result of hallucinogen abuse can receive long-term professional medical care in a residential rehabilitation center. Residents of halfway houses reside at the house but continue working outside. These patients may be more vulnerable to relapse. Partial hospitalization provides a combination of psychotherapy and educational groups without having to reside at the hospital but is not the best support for the patient who is severely impaired. An intensive outpatient program is a nonresidential setup that only provides medication oversight, and this would not be the best choice to a patient who is severely impaired. p. 427

What is the most appropriate nursing diagnosis for a patient who exhibits impulsiveness and experiences a loss of relationships and occupation due to a focus on alcohol use? Risk for injury Hopelessness Risk for suicide Ineffective coping

Risk for suicide The nursing diagnosis that is most appropriate for a patient who exhibits impulsiveness and experiences a loss of relationships and occupation due to a focus on alcohol use is risk for suicide. The impulsive behavior is the key component that may result in the patient harming him- or herself. A patient at risk for injury exhibits signs that include impairment, overdose, withdrawal from substances, and hallucinations. A patient who displays hopelessness presents with a lack of initiative, is passive, and reports seeing no alternatives or personal control. Signs and symptoms of a patient with ineffective coping include the decreased use of social support, destructive behavior toward him- or herself and others, inadequate problem-solving, poor concentration, and a reported inability to cope.

Which are clinical features of fetal alcohol syndrome? Spina bifida Short stature Microcephaly Renal agenesis Craniofacial malformations

Short stature Microcephaly Craniofacial malformations Clinical features of fetal alcohol syndrome include short stature, microcephaly, and craniofacial malformations. Spina bifida and renal agenesis are not associated with fetal alcohol syndrome. p. 421

What is occurring in the patient with a substance abuse disorder who no longer responds to the effect of the substance? Addiction Tolerance Withdrawal Intoxication

Tolerance A patient with a substance abuse disorder who no longer responds to the effect of the substance is experiencing tolerance. Withdrawal is a set of physiological symptoms that occur when a person stops using a substance. Addiction is a primary chronic disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway of the brain. Intoxication occurs when a substance is used to excess. p. 409

The nurse is caring for a patient with a substance use disorder. What statement describes the correct way to deal with transference or countertransference for patient care in substance use disorders? A nurse remains objective throughout the process. A residential care facility is needed for monitoring. An ongoing evaluation of the patient may not be necessary. A new nurse will take over the responsibility of patient care in each session.

A nurse remains objective throughout the process. The nurse remains cautious about personal thoughts, opinions, and feelings, and remains objective throughout the process. A therapeutic relationship should be established between the nurse and the patient. There is no need of introducing a new nurse in each session. An ongoing evaluation of the process must be conducted to eliminate transference or countertransference. This is done to maintain the objectivity of the treatment process and teach the patient new skills to acquire a healthy lifestyle after recovery. A residential care facility is needed depending on the patient's health-related issues. This has no effect on the nurse-patient relationship. pp. 423-425

A patient describes experiences of having blackouts. The nurse suspects abuse of Alcohol Cocaine Mescaline Psilocybin

Alcohol Chronic abuse of alcohol is associated with blackouts (periods for which the patient has no memory). Abuse of cocaine produces feelings of euphoria. Abuse of mescaline and psilocybin causes alterations in perception. pp. 420-421

To identify possible complications, a nurse managing the care of patients experiencing alcohol withdrawal will focus on which assessments? Confusion Temperature Abdominal pain Increased appetite Rash development

Confusion Temperature Abdominal pain Medical complications associated with alcohol withdrawal include infections, hypoglycemia, gastrointestinal (GI) bleeding, undetected trauma, hepatic failure, cardiomyopathy with ineffective pumping, pancreatitis, and encephalopathy (generalized impaired brain functioning). A rash and increased appetite are not characteristic signs of any medical complication associated with alcohol withdrawal. p. 420

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested ReVia Clonidine Gamma-hydroxybutyrate (GHB) Levo-alpha-acetylmethadol (LAAM)

Gamma-hydroxybutyrate (GHB) The drugs most commonly used to facilitate a sexual assault (rape) are flunitrazepam, a fast-acting benzodiazepine, and GHB and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. LAAM is indicated as a second-line treatment for the treatment and management of opioid dependence if patients fail to respond to drugs like methadone. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Clonidine hydrochloride is a centrally acting α-agonist hypotensive agent. p. 411, Table 22.1

Which statements are true regarding substance addiction? Intoxication occurs as a result of years of substance use. Addiction is the result of emotional, not physical, factors. Hedonistic behaviors are demonstrated by the addicted individual. Addiction currently is described as being chronic and affecting motivation. The term commonly used to describe substance use disorders is addiction.

Hedonistic behaviors are demonstrated by the addicted individual. Addiction currently is described as being chronic and affecting motivation. The term commonly used to describe substance use disorders is addiction. A term that people commonly use to describe substance use disorders is addiction. The most current definition of addiction states that it is a "primary, chronic disease of brain reward, motivation, memory, and related circuitry." It is a disease of dysregulation in the hedonic (pleasure seeking) or reward pathway of the brain. When people are in the process of using a substance to excess they are said be experiencing intoxication. pp. 408-409

Symptoms that would signal opioid withdrawal include Fatigue, lethargy, sleepiness, and convulsions Illusions, disorientation, tachycardia, and tremors Synesthesia, depersonalization, and hallucinations Lacrimation, rhinorrhea, dilated pupils, and muscle aches

Lacrimation, rhinorrhea, dilated pupils, and muscle aches Symptoms of opioid withdrawal resemble the flu; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever. The characteristic symptoms of opioid withdrawal are not described accurately as illusions, disorientation, tachycardia, tremors, fatigue, lethargy, sleepiness, convulsions, synesthesia, depersonalization, and hallucinations. p. 416

What should the nurse make a priority for the care of a patient hospitalized with a history of cocaine abuse? Promoting sleep in the patient Assisting the patient in setting goals Encouraging hygiene practices in the patient Developing a therapeutic relationship with the patient

Promoting sleep in the patient Most often, substance abuse results in the neglect of personal needs such as sleep and food. Therefore, the nurse should first aim to promote sleep and safety in the patient. Assisting the patient in setting goals can be done once the patient's condition is stabilized. It instills hope and direction in the patient. The patient is encouraged to perform self-hygiene practices to improve self-esteem. Thereafter, the patient is helped in exploring harmful thoughts and anxieties by developing a therapeutic relationship. pp. 410, 418, 424

The term tolerance, as it relates to substance abuse, refers to The use of a substance beyond acceptable societal norms The additive effects achieved by taking two drugs with similar actions The need to take larger amounts of a substance to achieve the same effects The signs and symptoms that occur when an addictive substance is withheld

The need to take larger amounts of a substance to achieve the same effects With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. The use of a substance beyond acceptable societal norms, the additive effects achieved by taking two drugs with similar actions, and the signs and symptoms that occur when an addictive substance is withheld do not correctly describe the term tolerance. p. 409

What information is important for the nurse to understand when initiating the use of naltrexone prescribed for alcohol relapse prevention? The tablets will be taken three times a day. Medication can begin on the fifth day of abstinence from alcohol. The patient needs to be opiate-free for 10 days before starting the medication. The patient must avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol.

The patient needs to be opiate-free for 10 days before starting the medication. It is important that the nurse ensure the patient is opiate-free for 10 days before starting naltrexone for alcohol relapse prevention. Acamprosate calcium tablets are taken three times a day and initiated on the fifth day of abstinence from alcohol. The patient prescribed disulfiram should avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol. p. 425

The patient tells the nurse, "I have been smoking pot for several years to help me sleep, and I want to quit." What statement made by the nurse reflects accurate information? "You may experience insomnia and disturbing dreams." "Marijuana has very little effect on the quality of your sleep." "You will be provided a prescription for an antianxiety medication." "You should not experience any symptoms if you only smoke it at night."

"You may experience insomnia and disturbing dreams." When people use cannabis as a sleep aid, insomnia and disturbing dreams may ensue without it. Cannabis causes drowsiness and impairs motor skills for eight to ten hours. Antianxiety medications are not prescribed for treatment of cannabis withdrawal. The patient will experience some symptoms after a prolonged use of the drug, even if use has only been at night. p. 414

A patient is trying to quit the habit of drinking alcohol. Which symptoms does the nurse recognize as the effect of mild alcohol withdrawal? Anorexia Insomnia Restlessness Hypersensitivity Grand mal seizures

Anorexia Insomnia Restlessness Mild alcohol withdrawal occurs as the alcohol concentration in the blood slightly reduces. It can lead to anorexia or loss of appetite, insomnia or lack of sleep, and restlessness. Hypersensitivity to noise and light, and grand mal seizures occur in extreme cases of severe alcohol withdrawal as the alcohol concentration in the blood is greatly reduced. p. 420

What symptoms suggest the use of marijuana by a patient? Hallucinations and sweating Violent behavior and psychosis Disorientation and memory loss Increased heart rate and appetite

Increased heart rate and appetite A patient who has been using marijuana will have an increased heart rate and appetite. People who use marijuana often get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from gamma-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD). p. 410, Table 22.1

How does the advanced practice nurse integrate motivational interviewing as a tool in the treatment plan of a patient with a substance use disorder? It introduces an alternative treatment process that is parallel to the current treatment process. It assesses the substance-related disorder and determines if other comorbidities are present. It modifies the current treatment process by allowing the nurse to evaluate the process frequently and gives input related to health care. It helps the advanced practice nurse assess the stage of change the patient is in and match it with an appropriate treatment process.

It helps the advanced practice nurse assess the stage of change the patient is in and match it with an appropriate treatment process. An advanced practice nurse first understands the change that is occurring in the individual as it relates to the patient's substance use disorder. Then, the nurse assists the patient in correlating the change in the individual with the treatment process. A nurse works as a part of the treatment process rather than introducing an alternative plan. A nurse assists the patient to develop coping skills and motivates the patient to follow the treatment plan. The evaluation of the treatment plan is not a part of counseling. The assessment of substance use disorder and comorbidities is done after the screening and based on that assessment, the counseling starts. p. 425

The treatment team meets to discuss the plan of care for a patient diagnosed with addiction to heroin. Which factor will have priority when planning interventions? Financial ability Readiness to change Current college performance Availability of immediate family

Readiness to change The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. Current college performance, financial ability, and availability of immediate family may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital. pp. 423-424

The nurse notices withdrawal symptoms in a patient with substance use disorder. What is the priority substance use disorder outcome measure when planning the care of this patient? Motivation for treatment Stabilization of the patient Pursuit of a recovery lifestyle Maintenance of proper nutrition intake

Stabilization of the patient The patient needs to be medically stable before addressing nutrition or recovery. Maintenance of proper nutrition is important for patients with substance abuse because their nutrition is often either less or more than their body requires. If the patient is actively using the substance, motivation for treatment is an important outcome measure. Pursuit of recovery lifestyle is a desired outcome measure for the postdischarge period. However, when the patient has withdrawal symptoms, stabilization of the patient is of primary importance. p. 423

Which statement supports that the patient may be developing a tolerance? "Over the years it has taken more alcohol to get me drunk." "If I don't drink my usual amount of alcohol, I get nervous and jumpy." "I've learned that I may develop a tolerance for my heart medicine." "Drinking a bottle of wine today doesn't affect me like it did five years ago." "I need to tell my health care provider that my antidepressant isn't working like it did."

"Over the years it has taken more alcohol to get me drunk." "I've learned that I may develop a tolerance for my heart medicine." "Drinking a bottle of wine today doesn't affect me like it did five years ago." "I need to tell my health care provider that my antidepressant isn't working like it did." People with addictions experience tolerance to the effects of their respective substances. Tolerance is either needing increasing amounts of a substance to receive the desired result or finding that using the same amount over time results in a much-diminished effect. Some prescribed medications might have the same effect, such as some antianxiety medications, analgesics, and beta-blockers. Even antidepressants may result in tolerance. Withdrawal is a set of physiological symptoms that begin to occur as the concentration of the chemical decreases in an individual's bloodstream. It will be specific to the substance ingested, and each substance will have its own characteristic syndrome. p. 409

A patient is undergoing detoxification for heroin abuse at a residential rehabilitation program. What teaching by the nurse can help prevent a relapse in the future? Assisting in the development of awareness and commitment Counseling to identify the potential triggers of substance use Helping the patient understand and admit that there is a problem Helping in acquiring skills to regain abstinence in the event of relapse Teaching stress management skills to address triggers that may lead to substance use Counseling on adopting healthy coping measures and a sustainable recovery lifestyle

Counseling to identify the potential triggers of substance use Helping in acquiring skills to regain abstinence in the event of relapse Teaching stress management skills to address triggers that may lead to substance use Counseling on adopting healthy coping measures and a sustainable recovery lifestyle Individuals must prepare for and anticipate the possibility of relapse to maintain long-term sobriety. A nurse can help in identifying the triggers to substance use, and teaching the patient to regain abstinence in the event of a relapse. The patient should learn how to handle stress effectively. The patient is counseled on healthy coping measures and how to sustain a healthy life after treatment. Precontemplation is the initial stage of admitting that there is a problem of addiction so that an assessment can start. Helping the patient understand the problem and admit there is a problem is important, but it is not part of a teaching plan. The development of awareness and a commitment is at the very beginning of the treatment of addiction. Assisting the patient to develop awareness is also not part of a teaching plan. p. 427

A patient is brought to the emergency room with extreme alcohol intoxication. Which health effects of high doses of alcohol does the nurse expect to find in the patient? Drowsiness Constipation Slurred speech Loss of coordination Low body temperature

Drowsiness Slurred speech Loss of coordination Low body temperature High doses of alcohol adversely affect the nervous system and may cause drowsiness, slurred speech, reduction in body temperature, and loss of coordination. These effects are due to the depressive action of alcohol on the brain and the nervous system. Constipation is an aftereffect seen with the intake of opium. p. 420

Which statement regarding nursing practice and addiction treatment is true? Every nurse needs to be familiar with the addiction screening process. Every nurse should be familiar with the referral process regarding addiction. Hospitals are responsible for educating nurses regarding the addiction process. All practice areas require that nurses understand the disease of addiction. Comprehensive addiction treatment is based on an effective assessment process.

Every nurse needs to be familiar with the addiction screening process. Every nurse should be familiar with the referral process regarding addiction. All practice areas require that nurses understand the disease of addiction. Comprehensive addiction treatment is based on an effective assessment process. It is important for all nurses, regardless of their practice area, to develop an understanding of the disease of addiction. Nursing curricula should include the content and practicing the skills necessary for addiction screening, early detection, and referral to appropriate treatment. Without an accurate assessment for substance use and other mental health disorders, individuals will be unable to receive comprehensive treatment planning and quality care. The education of nurses is not the responsibility of hospitals but rather schools of nursing. pp. 408, 422-423

How could being part of a family where there is alcoholism and codependency affect nurses in their profession? Codependency in families helps the nurses to learn better stress management skills. Nurses with codependency may see themselves as providers of care, excluding their own needs. Codependency in families teaches the nurses to be objective and helps in patient care. Nurses with codependency often live a full and satisfying life by caring for others.

Nurses with codependency may see themselves as providers of care, excluding their own needs. The nurses may be at higher risk for relationship difficulties related to codependence if they have grown up in environments where one or more family members were addicted. This may play a role for the nurses to choose this profession because they see themselves as care providers for the patient. This disrupts the objectivity of the treatment process. A codependent person develops an attitude of helping others excluding one's own self and that prevents the person from living a full, satisfying life. Codependency does not help to manage stress. Rather, the individuals may develop maladaptive thoughts or behaviors that may bring on stress in their lives. p. 423

The nurse is assessing a patient brought to the emergency room with tachycardia, hypertension, and hyperthermia. On examination, the nurse finds the pupils are dilated and the reflexes are heightened. What does the nurse suspect this condition to be? Opioid withdrawal Opioid intoxication Alcohol withdrawal Stimulant withdrawal

Opioid withdrawal Opioid withdrawal manifests as a set of physiologic symptoms that begin to occur when the concentration of opium decreases in the patient's bloodstream. It is characterized by tachycardia, hypertension, and hyperthermia. These symptoms are not caused by opioid intoxication, alcohol withdrawal, or stimulant withdrawal. Opioid intoxication is characterized by decreased heart rate, blood pressure, body temperature, body reflexes, and pinpoint pupils. Alcohol withdrawal is characterized by restlessness, irritability, impairment in functioning, and trembling. Stimulant withdrawal is characterized by depression, poor concentration, and paranoia. p. 416, Box 22.1

The nurse observes a patient in the intensive care unit (ICU) with insomnia who used to take opioids for chronic pain. After diagnosis, the nurse finds that the patient has enlarged pupils associated with continuous tearing of the eyes. In the report the nurse would document that the patient was showing signs of what? Opioid withdrawal Opioid intoxication Stimulant withdrawal Stimulant intoxication

Opioid withdrawal Screening or diagnosis of substance use disorders includes identification of related symptoms. Symptoms of opioid withdrawal are characterized by difficulty in regular sleep pattern (insomnia), enlarged pupils (mydriasis), and continuous tearing of eyes. These symptoms do not indicate opioid intoxication, stimulant withdrawal, or stimulant intoxication. Opioid intoxication is characterized by bradycardia, feelings of sedation, and pinpoint pupils (meiosis). Stimulant withdrawal is characterized by symptoms ranging from decreased energy and dilated pupils to depression, chest pain, and irregular breathing pattern. Stimulant intoxication is characterized by fatigue, anxiety, and irritability. p. 416, Box 22.1

A nurse is teaching high school students about commonly abused drugs and their effects. Which common substances are abused through swallowing? Opium Heroin Alcohol Nicotine Marijuana

Opium, Alcohol, Marijuana The substances that are abused by swallowing included opium, alcohol, and marijuana. Opium is an opioid that can be swallowed and smoked. Alcohol is found in liquor, beer, and wine and is abused through swallowing. Marijuana is a cannabinoid and can be swallowed and smoked. Nicotine is the main ingredient in tobacco and is smoked, snorted, or chewed. Heroin is an opioid and can be injected, snorted, and smoked. pp. 410-412, Table 22.1

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be a priority outcome for this patient's treatment plan while in the hospital? Patient will be medically stabilized while in the hospital. Patient will return to a predrug level of functioning within 1 week. Patient will take a leave of absence from college to alleviate stress. Patient will state within 3 days that he or she will totally abstain from drugs and alcohol.

Patient will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he or she will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal, such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. It is not likely that the patient will make a total commitment to abstinence within 1 week. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely. p. 423

The nurse is assessing an individual for substance abuse disorder. What initial assessments does the nurse do to determine a proper plan of treatment and care? Pattern of substance use Assessment of comorbidities Clinical examination of background Strength and level of willingness to change Willingness for a referral to a support group Assessment of measures to prevent relapse

Pattern of substance use Assessment of comorbidities Clinical examination of background Strength and level of willingness to change The initial assessment involves a clinical examination of the background, including the patient's history, any history of trauma, a family history of substance use or mental health problems, and any disabilities. Knowledge about the pattern of substance use, such as type of substance, frequency, age at initiation, and so forth, helps in properly planning the treatment and care. An individual's strengths and level of willingness to undergo the treatment helps in planning the treatment strategy. Assessment of comorbidities is also done because they may need to be treated simultaneously. A discussion pertaining to a support group takes place in the planning phase, and a support group is involved in the treatment process. It is not a part of the initial assessment. The relapse prevention measures are discussed after the detoxification or rehabilitation is successfully completed. pp. 423, 427

A nurse is learning how to manage patients with substance abuse disorders. Which step should the nurse apply as a first-line intervention in such cases? Sedating the patients Secluding the patients Providing safety and sleep Encouraging strenuous activities

Providing safety and sleep Because patients with substance use disorders are under variable influence of the drug effects, providing safety and sleep is essential to help the body recover. Strenuous activity should be avoided to prevent fatigue. Seclusion and sedation may not help the patient; these measures are used only when the patient is aggressive and harmful to self or others. p. 424

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? Supervisory staff should be informed as soon as possible in both cases. Neither should be reported until the nurse has collected factual evidence. No report should be made until suspicions are confirmed by a second staff member. The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place.

Supervisory staff should be informed as soon as possible in both cases. If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by coworkers is crucial. The nurse manager's major concerns are with job performance and patient safety. Reporting an impaired colleague is not easy, even though it is a responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug. p. 423

Why is cognitive-behavioral therapy indicated in a patient with an addiction? To enhance motivation in the patient To allow a sustainable recovery lifestyle To break the denial behavior of the patient To identify irrational core beliefs in the patient

To identify irrational core beliefs in the patient Cognitive-behavioral therapy is conducted for a patient who has an addiction in order to identify irrational core beliefs. Mindfulness and meditation are helpful in sustaining a recovery lifestyle. Motivational interviewing is a technique that helps assess the status of the patient and break denial while enhancing motivation. Cognitive-behavioral therapy aids the patient in exploring thought patterns so that core beliefs can be analyzed. p. 425

Which response is appropriate when teaching a patient regarding a prescription for naltrexone? "It will keep you from experiencing flashbacks." "It helps prevent relapse by reducing your drug cravings." "It helps your mood so that you don't feel the need to do drugs." "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions."

"It helps prevent relapse by reducing your drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. Improving mood, preventing flashbacks, and helping one to sleep do not describe accurately the action of naltrexone. p. 417

A patient is brought to the emergency department for suspected inhalant intoxication and is exhibiting signs of severe agitation and aggression. What plan of care does the nurse anticipate to help stabilize the patient? Administer naloxone. Administer haloperidol. Place the patient in restraints. Keep the patient calm; intoxication is self-limiting.

Administer haloperidol. The nurse will anticipate administering haloperidol, which can be used carefully to manage severe agitation for patients experiencing inhalation intoxication. Restraints should be used judiciously and only after other interventions have been tried or if the patient tries to harm him- or herself or others. Naloxone is used to treat narcotic overdoses. Severe agitation and aggression can occur as a result of inhalant intoxication and is self-limiting, lasting a few hours to a few weeks. It may not be possible to keep the patient calm. Test-Taking Tip: Look for options that are similar in nature. If all are correct, the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option. p. 415

The nurse suspects a patient of substance abuse. What should be the nurse's first intervention? Referral to detoxification program Positron emission tomography of the brain Magnetic resonance imaging study of the brain Assessment for substance use and comorbidities

Assessment for substance use and comorbidities An accurate assessment for substance use and other mental health disorders is the key to successful treatment planning. The nurse needs to determine what substance or substances the patient is using, as well as identify underlying medical and mental health disorders that may affect treatment. A referral is done after the assessment and counseling. Magnetic resonance imaging and a positron emission tomography help in understanding the underlying neurobiology of the brain. They provide better understanding of the mental health disorder and help in detection and treatment. p. 422

Which assessment data would be most consistent with a severe opiate overdose? Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. p. 416, Box 22.1

The nurse is performing an assessment of a patient who has a history of drug abuse and has many injection marks on the arm. Which drug should the nurse suspect the patient to be abusing? Opium Cocaine Hashish Marijuana

Cocaine Cocaine is a stimulant and is administered by snorting, smoking, or injecting. Opium is an opioid that is swallowed or smoked. Hashish is a cannabinoid that is smoked or swallowed. Marijuana is a cannabinoid that is smoked or swallowed. pp. 410-412, Table 22.1

A nurse cares for a patient hospitalized 3 days ago with gastrointestinal bleeding. Today, the patient is irritable and restless and complains to the nurse, "There is too much noise in this hospital. The lights are so bright they are blinding me." What is the nurse's best action? Conduct a thorough search in the patient's room for hidden alcohol. Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Assess for a delayed reaction to a blood transfusion given the first day of hospitalization. Notify the facility's maintenance manager to adjust the lighting and intercom level in the patient's room.

Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Gastrointestinal bleeding is a medical complication of chronic alcohol abuse; the admitting diagnosis is a clue to be observant for alcohol-related problems. Hypersensitivity to noises (which seem louder than usual) and light (which appears brighter than usual) is associated with severe alcohol withdrawal. Irritability and restlessness are additional clues to alcohol withdrawal. If the patient had been using alcohol from a hidden source, he or she would not be experiencing alcohol withdrawal. Reactions to blood transfusions occur immediately. After assessing the patient, the nurse may decide to adjust the room's lighting and noise. p. 421

A nurse interviews a 15-year-old who has engaged in frequent substance abuse. In addition to assessing substance abuse, the nurse should screen for which other problems in this adolescent? Depression Eating disorder Conduct disorder Antisocial personality Obsessive-compulsive disorder

Depression Eating disorder Conduct disorder Antisocial personality The high prevalence of psychiatric comorbidity is supported by statistics from multiple national population surveys. Individuals with mood and anxiety disorders, antisocial behaviors, or histories of conduct or oppositional disorders as adolescents are more than twice as likely to have a substance use disorder. Eating disorders may occur in people abusing stimulants or caffeine. Obsessive-compulsive disorder is not a comorbidity associated with substance abuse. pp. 412, 414, 427

Which medication prescribed to a patient for treatment of alcohol addiction may be associated with intense vomiting, respiratory difficulty, and mental confusion? Disulfiram Phenobarbital Chlordiazepoxide Acamprosate calcium

Disulfiram Disulfiram is used for the maintenance of alcohol abstinence. However, the medication should be taken consistently to maintain the alcohol aversion. Alcohol consumption while on disulfiram leads to a toxic reaction that results in symptoms such as intense nausea, vomiting, respiratory difficulty, and mental confusion. Chlordiazepoxide is used to reduce withdrawal agitation and can cause sedation and seizures. Phenobarbital could result in sedation. Acamprosate calcium causes side effects such as itching, diarrhea, and intestinal gas. p. 425, Table 22.6

How should the nurse begin a brief intervention for a patient addicted to cigarettes? Give feedback to the patient about personal risk. Provide information about smoking cessation tools. Set agreeable goals for reducing cigarette smoking. Arrange a follow-up or specialty referral for the patient.

Give feedback to the patient about personal risk. The nurse can begin an effective intervention for a patient who is addicted to cigarettes by first providing feedback to the patient about personal risk. This first step helps the patient understand the benefits of smoking cessation. Setting agreeable goals for reducing is a follow up intervention once the patient is ready to begin cessation. The nurse should arrange a follow-up or specialty referral for the patient and provide information regarding tools that may help the patient quit smoking. p. 410, Table 22.1

Cocaine exerts which of the following effects on a patient? Paranoia Drowsiness Increased metabolism Immediate imbalance of emotions

Increased Metabolism Cocaine exerts a stimulant effect on metabolism. p. 410, Table 22.1

The nurse planning educational materials for parents of children with a history of opioid abuse will emphasize which signs when discussing opioid withdrawal? Sweating Runny nose Sleeplessness Slurred speech Enlarged pupils

Sweating Runny nose Sleeplessness Enlarged pupils Signs of opioid withdrawal include dilated pupils, insomnia, diaphoresis, and rhinorrhea. Slurred speech is associated with opioid intoxication. p. 416, Box 22.1

The nurse cares for a patient with chronic pain. A regular dose of analgesic medication is ineffective in reducing the patient's pain. What does the nurse expect is the cause for the patient's response? The patient is showing signs of tolerance. The patient is showing signs of withdrawal. The patient is showing signs of intoxication. The patient is showing signs of hyperreactivity.

The patient is showing signs of tolerance. The nurse expects that the patient is showing signs of tolerance because the regular dose of an analgesic drug is ineffective in reducing the patient's pain. Tolerance is the phenomenon in which a patient may need increased amounts of a drug to produce the desired effects, or a constant drug dose may cause diminished effects over time. Withdrawal symptoms are seen when the drug concentration in the blood is reduced. Analgesic drugs generally do not cause significant withdrawal symptoms. The excessive usage of a drug results in intoxication. Analgesic drugs do not cause intoxication. Generally, stimulant drugs cause hyperreactivity. Analgesic drugs do not cause hyperreactivity. p. 413

A nurse is caring for a patient who has been abusing stimulants. Which symptoms does the nurse look for as a risk for suicide? Hallucinations Impulsiveness Social isolation Loss of occupation Elevated temperature

Impulsiveness Social isolation Loss of occupation Impulsiveness decreases the decision-making abilities and increases the patient's risk for suicide. Social isolation and loss of occupation can make the patient feel depressed and lonely, which increases the patient's risk for suicide. Hallucinations are altered perceptions, which may interfere with clear thinking and increase the patient's risk for injuries. Elevated temperature increases the patient's risk for injuries. p. 424, Table 22.5

A patient has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include Induction of vomiting Observation for cardiac dysfunction Administration of ammonium chloride Monitoring of opiate withdrawal symptoms

Observation for cardiac dysfunction Cardiac dysfunctions are observed in patients experiencing central nervous system stimulant overdose. p. 418, Box 22.2

A patient hospitalized after a heroin overdose shares, "I've been using more heroin lately to get my usual high." The nurse determines that this information supports the existence of what abuse-related outcome? Tolerance Addiction Intoxication Withdrawal

Tolerance Tolerance is described as needing increasingly greater amounts of a substance to become intoxicated or finding that using the same amount over time results in a much diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. p. 409

Nursing assessment of an alcohol-dependent patient experiencing uncomplicated moderate alcohol withdrawal would most likely reveal the presence of Tremors Seizures Blackouts Hallucinations

Tremors Tremors are a sign of mild to moderate alcohol withdrawal. Hallucinations, seizures and blackouts would indicate complicated or severe ETOH withdrawal. p. 420

What term is used to identify a syndrome that occurs after stopping the long-term use of a drug? Enabling Amnesia Tolerance Withdrawal

Withdrawal Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage. Amnesia, tolerance, and enabling are not used to identify the described event. p. 409

A patient is administered naloxone for an opioid overdose. What withdrawal symptoms does the nurse anticipate? Yawning Rhinorrhea Nystagmus Lacrimation Piloerection

Yawning Rhinorrhea Lacrimation Piloerection Withdrawal symptoms the nurse can anticipate include rhinorrhea, yawning, lacrimation, and piloerection. Nystagmus occurs in patients experiencing phencyclidine intoxication. p. 415

The nurse is caring for a woman with chronic alcohol intoxication. The woman is prescribed disulfiram to treat the condition. Which information given by the nurse is appropriate about disulfiram? "You may experience adverse effects if you consume alcohol." "You may experience nausea during the course of medication." "You may experience seizures during the course of medication." "You may experience sedation during the course of medication."

"You may experience adverse effects if you consume alcohol." The nurse is caring for a woman with chronic alcohol intoxication. The woman is prescribed disulfiram to treat the condition. Which information given by the nurse is appropriate about disulfiram? "You may experience adverse effects if you consume alcohol." "You may experience nausea during the course of medication." "You may experience seizures during the course of medication." "You may experience sedation during the course of medication."

The nurse assesses a patient who abuses various substances and discovers significant dental problems. The nurse expects that this patient abuses which substance? Opiates Alcohol Inhalants Methamphetamines

Methamphetamines Abuse of methamphetamine is associated with severe dental problems. If opiates are injected, damage to the skin and veins occurs. Alcohol abuse is associated with gastrointestinal erosion as well as other physiologic consequences. Abuse of inhalants is damaging to the respiratory tract. p. 410, Table 22.1

When caring for a patient who is intoxicated from alcohol, which need has the highest priority? Self-esteem needs Safety and security Physiologic stability Cultural preferences

Safety and security The plan should address safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and cultural needs. Safety is the highest priority because of the patient's imminent risks for injury while intoxicated. Physiologic stability has the second highest priority. p. 424