week 6 MH

what is binge drinking

4 or more drinks in 2 hours for women 5 or more

A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.

ANS: A The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

ANS: A Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.

A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: A, CThe nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.

ANS: AThe most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."

ANS: BA positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.

A client diagnosed with alcohol abuse joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

ANS: C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

ANS: CThe nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

ANS: D A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

Tobacco withdrawal symptoms

At least four of the following symptoms occur: irritability, anxiety, depression, difficulty concentrating, restlessness, and insomnia. Within days after smoking cessation, heart rates decrease by 5 to 12 beats per minute

A nurse is assessing a client who is experiencing alcohol withdrawal. For which of the following findings should the nurse anticipate the administration of lorazepam? A. Decreased pulse rate B. Increased blood pressure C. Decreased urinary output D. Increased nausea

Correct Answer: B. Increased blood pressure Lorazepam is a benzodiazepine that is administered to a client who is experiencing alcohol withdrawal for stabilizing vital signs, preventing seizures, and treating delirium tremens. The nurse should anticipate the provider to prescribe lorazepam for increasing blood pressure.

A nurse is developing a plan of care for a client who has alcohol use disorder. Which of the following medications should the nurse plan to administer? A. Methadone B. Varenicline C. Buprenorphine D. Diazepam

Correct Answer: D. Diazepam The nurse should plan to administer diazepam to a client who has alcohol use disorder to minimize manifestations of alcohol withdrawal.

symptoms of neuroleptic malignant syndrome

FEVER fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles

CAGE questionnaire

Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)? 2 or more significant

physical symptoms of hallucinogen

Physical symptoms include pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremors, and incoordination.

defense mechanism splitting

Seeing others as all bad or all good

cannabis withdrawal symptoms

Symptoms include irritability, anger, aggression, anxiety, restlessness, and depressed mood. Because people often use 890marijuana as a sleep aid, insomnia and disturbing dreams may ensue

treatment of someone who took PCP

THEY cannot be talked down and may require restraint and a calming medication such as a benzodiazepine

A chronic alcoholic is admitted to the medical unit for pneumonia. Which medication would the nurse expect the health-care provider to prescribe to prevent delirium tremors? a. chlordiazepoxide (Librium) b. Thiamine (vitamin B1) c. disulfiram (antabuse) d. fluoxetine (Prozac)

a. Librium/chlordiazepoxide =benzodiazepine

Wernicke's encephalopathy is characterized by

Wernicke's encephalopathy is characterized by altered gait, vestibular dysfunction, confusion, and several ocular motility abnormalities (horizontal nystagmus, lateral orbital palsy, and gaze palsy).

when can alcohol withdrawal seizures occur

Withdrawal seizures may occur within 12 to 24 hours after alcohol cessation. These seizures are generalized and tonic-clonic

what are the strong signs of opioid overdose

—coma, pinpoint pupils, and respiratory depression

Personality traits associated with drug abuse include: (select all) a. narcissistic behavior b. introverted personality c. established impulse control d. difficulty dealing with intimacy e. low self-esteem

a. narcissistic behavior and e. low self-esteem

Signs and symptoms of fetal alcohol syndrome include: (select all) a. microcephaly b. growth retardation c. short palpebral fissures d. maxillary hypoplasia e. hypotension

a/b/c/d

. A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply. a. Intense nausea b. Diaphoresis c. Acute paranoia d. Confusion e. Dyspnea

a/b/d/e

A nurse is caring for a client who has a history of opioid and heroin abuse and monitoring for signs of withdrawl. which clinical manifestations are associated with heroin and opioid withdrawl. (select all) a. compulsive itching b. diaphoresis c. yawning and sneezing d. insomnia e. cramps and diarrhea

all

opiod and narcotic risk factors include but are not limited to:(select all) a. constipation b. endocarditis c. fatal overdose d. HIV

all

Misplacing things and losing the ability to retrace steps is indicative of age related changes or alzheimers

alzheimers

when and how to administer cholinesterase inhibitors such as donepezil/rivastigmine/galantmine

at bedtime and with or without food

preservation

avoids answering questions by repeating phrases or behavior

what is the classic sign of alcohol withdrawal and when does it start

classic sign of alcohol withdrawal is tremulousness, commonly called the shakes or the jitters, that begins 6 to 8 hours after alcohol cessation

a patient is withdrawing from what substance with these manifestations fatigue/dramatic unpleasant dreams/excess sleeping/agitation

cocaine

Paula is attending an education class on addictive disorders. She suspects that her husband may be abusing opiates since he has been taking pills given to him by his brother and she knows the brother had been taking oxycodone for back pain. She asks the nurse how to interpret her husband's behaviors. Which of the following observations by Paula are consistent with opioid intoxication? Select all that apply .1) "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." 2) "Last night he went out without a coat on and it was 15 degrees outside." 3) "While we were talking at dinner his speech was rapid and he seemed hyperalert to everything in the environment." 4) "He's been having trouble remembering things." 5) "Sometimes it looks like his pupils are very small."

correct 1: One manifestation of opioid intoxication is an initial period of euphoria followed by apathy, which is indicated by her statement that "sometimes he acts like he doesn't care about anything."Correct 2: Going outside without a coat in subfreezing weather could be inferred as impaired judgment, which is consistent with opioid intoxication.Feedback 3: Rapid speech and hypervigilance are more consistent with stimulant intoxication. In opioid intoxication one would expect to see mental cloudiness.Correct 4: Impairment in attention and memory is consistent with opioid intoxication.Correct 5: Paula is describing pupillary constriction, which is consistent with opioid intoxication.

Opioid withdrawal symptoms

dysphoria(state of unease), nausea, vomiting, diarrhea, muscle aches, fever, and insomnia. Other classic symptoms of withdrawal are lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation, and yawning

how is the memory in early and late alzheimers

early forget recent things late forget remote memory (distant)

nyctophobia

fear of darkness

what blood tests should be performed while taking quetiapine fumarate

glucose

2 types of delirium

hypoactive =no agitation hyperactive=with agitation

Apraxia

inability to perform particular purposive actions, as a result of brain damage. For example, in apraxia of dressing, the person is unable to put clothes on properly (may put arms in trousers or put a jacket on upside down).

what setting is necessary for amphetamine withdrawal

inpatient

Traits that may be seen in an addict are:(select all) a. manipulative b. impulsive c. halitosis d. anxious

manipulative/impulsive/anxious

what are illusions

misperceptions of real external stimuli

a patient in what stage (3) of alzheimers will need help choosing clothes for weather

moderate

side effects of cholinesterase inhibitors donepezil(Aricept) rivastigmine (Exelon)

nausea, vomiting, diarrhea, insomnia, fatugue, muscle cramps, incontinence, bradycardia, and syncope

a patient is withdrawing from what substance with these manifestations insomnia/pupil dilation/piloerection/sweating/rhinorrhea

opiods- heroin/morphine/hydropmorphone

opioid intoxication symptoms

psychomotor retardation, drowsiness, slurred speech, altered mood, and impaired memory and attention. They also exhibit pupillary constriction

The nurse is completing and admission assessment for a client admitted with acute alcohol intoxication. When asked to describe drinking pattern and amount, the client states, "I only drink when I am under a lot of stress." The clients response indicates what defense mechanism? a. projection b. regression c. denial d. rationalization

rationalization

when is agnosia seen in alzheimers and what is it

severe alzheimers inability to identify familiar objects or people

Hypermetamorphosis

the desire to touch everything in sight

what is methadone used for

used to decrease the painful symptoms of opiate withdrawal.

what is the reasoning for validation therapy

validation therapy does not attempt to orient the client to reality but instead validates the underlying feelings expressed by the client and redirects the conversation.

nicotine abstinence drugs

varenicline, rimonabant

cannabis withdrawal usually occurs

within 1 week