Addiction
Which psychological condition is one of the most prevalent precursors of substance abuse among adults aged 45 to 60? A: Schizophrenia B: Borderline personality disorder C: Depression D: Obsessive-compulsive disorder (OCD)
Answer: C
Which substance does not utilize formal detoxification protocols for withdrawal? (Select all that apply.) A. Nicotine B. Opioid C. Cocaine D. Benzodiazepines E. Alcohol
A ,B, C Rationale: Formal detoxification protocols are often not required when withdrawing from opioids, cocaine, and nicotine, with support being primarily for unpleasant symptom management. Detoxification protocols are needed for withdrawal from alcohol and benzodiazepines to manage serious medical consequences such as seizures (for alcohol and benzodiazepines) and delirium tremens (alcohol). After detoxification has occurred, clients who have used any of the listed substances often require medications for cravings to prevent relapse.
Group Therapy
A beneficial experience in which the group members help each other with psychological, cognitive, behavioral, and spiritual dysfunctions through a process of change, aided by a professional group therapist.
Delirium Tremors (DTs)
A medical emergency usually occurring 3-5 days after alcohol withdrawal and lasting 2-3 days; characterized by paranoia, disorientation, delusions, visual hallucinations, elevated vital signs, vomiting, diarrhea, and diaphoresis (AKA: alcohol withdrawal delirium)
Dependence
A physiological need for a substance that the client cannot control, and that results in withdrawal symptoms if the substance is withheld.
Addiction
A psychological or physical need for substance (alcohol) or process (gambling) to the extent that the individual will risk negative consequences in an attempt to meet the need. [Process addictions involve compulsive behaviors that serve to reduce anxiety]
A pregnant client at 20 weeks' gestation is admitted for dehydration after trying to detox in the home environment. The client reports being nauseated and vomiting for the past week. During the plan of care, the nurse determines that the client will have a diagnosis of Nutrition, Imbalanced: Less than Body Requirements. Which nursing goal is appropriate for this client? (Select all that apply.) A. The client will verbalize negative effects of substance use on the body. B. The client will maintain body weight. C. The client will remain free of signs of infection. D. The client will verbalize negative effects of substance use on fetal health. E. The client will maintain fluid balance.
A, B, D, E Rationale: The nursing goals for the client who is at 20 weeks' gestation admitted for dehydration after trying to detox in the home environment are to maintain fluid balance and body weight and to verbalize the negative effects of substance use on both the fetus' health and their own health. The focus of the nursing goal is on nutrition, not infection.
A student nurse is writing a research paper on addiction risk for a psychology class. Which sociocultural group will the student include as having a high risk of abusing alcohol? A: Lesbian women B: Buddhist nuns C: Bisexual men D: Muslim men
Answer: A
An adult client expresses concern that her mother has seemed somewhat distracted and lethargic recently. She is concerned that her mother has dementia. In addition to other inquiries, why does the nurse ask the client about the possibility that her mother is abusing a substance? A: Diagnosis of substance abuse is often complicated by its symptoms appearing to be symptoms of such other disorders as diabetes, depression, and dementia. B: Dementia is an overdiagnosed disorder. C: The nurse is studying to be a Certified Substance Abuse Counselor. D: Substance abuse is a minimal problem in the elderly but should be ruled out.
Answer: A
Which data are collected during the physical examination of a client diagnosed with addiction? A: Focused assessment of skin B: Family interview C: A symptom questionnaire D: Chest x-ray
Answer: A
The nurse is collecting data on clients at a clinic. One client has risk factors for substance abuse. What physical sign or signs did the nurse assess that suggest substance abuse in this client? Select all that apply. A) Dilated pupils B) Odor of alcohol on the breath C) Frequent accidents or falls D) Extremely low body weight E) Dressed in jeans and a t-shirt
Answer: A, B, D Explanation: A) Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle "track marks" or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing jeans and a t-shirt is not indicative of substance abuse.
A client who requires mandatory court-ordered drug testing is seen in the clinic. Which options can the nurse use to fulfill this court-required drug testing for this client? Select all that apply. A: Serum level testing B: Urine testing C: Genetic testing D: Hair testing E: Saliva testing
Answer: A, B, D, E
A nurse is conducting a physical assessment of a client with suspected substance abuse problems. Which finding may indicate the client is a substance abuser? A: Early-onset dementia B: Vital signs within normal limits C: Short stature D: Weight gain
Answer: A
A public health nurse is presenting a teaching session about alcohol use to a group of college seniors. During the session, one of the students admits to frequent alcohol use. What is the nurse's priority action? A) Initiate a community assessment of the campus B) Contact the campus nurse and refer the student for services C) Notify campus security that the student may be driving while intoxicated D) Complete a crisis assessment with the student
Answer: D Explanation: A) The student should be assessed to determine the extent of crisis he or she is facing as the result of frequent alcohol use. This crisis assessment will allow the nurse to determine the appropriate course of action. A community assessment is not necessary at this time because the issue appears to be limited to this particular student. Contacting the campus nurse is not advised without the student's permission. There is no evidence that the student is driving while intoxicated.
The nurse is preparing a presentation on substance use disorders for a community group. Which risk factor should the nurse include that predisposes the development of a substance use disorder? (Select all that apply.) A. Low income B. Mental illness C. Loneliness D. Divorce E. Family history
B, C, E Rationale: Mental illness, loneliness, and family history are risk factors that might predispose a client to develop a substance use disorder. Having a low income or being divorced does not predispose a client to developing a substance use disorder.
A client with a history of substance abuse denies using any narcotics. Which expected outcome should the nurse select for this client? (Select all that apply.) A. The client will participate in group therapy. B. The client will admit to having a problem with substance abuse. C. The client will remain free from injury. D. The client will verbalize the negative effects of alcohol on the body. E. The client will describe choices made that contributed to substance abuse
B, E The client admitting to a problem with substance abuse and the client describing choices made that contributed to substance abuse are both expected outcomes for a client diagnosed with Denial, Ineffective. These expected outcomes demonstrate the client's willingness and ability to recognize substance abuse as a problem. The client remaining free of injury, the client verbalizing the negative effects of alcohol on the body, and the client participating in group therapy are not expected outcomes for a diagnosis of Denial, Ineffective
A client tells the nurse that their husband often comes home late after drinking with friends and wakes up the family. The client doesn't want to say anything to the husband because "he works hard and needs to relax." Which behavior is the client exhibiting? A. Intervention B. Codependence C. Confrontation D. Collaboration
B. Codependence Rationale: Codependence involves behaviors of family members that support the addiction of another family member. An intervention is a planned attempt to get someone to seek professional help with an addiction. Collaboration is working together for a common goal. A confrontation is an act of angry opposition.
The nurse is caring for a client who overdosed on LSD. Which intervention should the nurse provide? (Select all that apply.) A. Administer renal dialysis as prescribed. B. Administer opioid antagonist as ordered. C. Speak slowly and clearly with the client. D. Reduce environmental stimuli. E. Have one person "talk down the client."
C, D, E Rationale: For LSD overdose, the nurse should reduce the environment stimuli and have one person "talk down the client." Speaking slowly and clearly with the client is also required. Renal dialysis is used for alcohol, barbiturate, or benzodiazepine overdose, and an opioid antagonist is used for heroin, meperidine, morphine, or methadone overdose. For LSD overdose, the nurse can expect a benzodiazepine or chloral hydrate to be used.
The nurse is caring for a client starting a smoking cessation treatment. Which type of drug should the nurse consider appropriate for treatment of the client's nicotine addiction? A. An antiseizure drug B. A benzodiazepine C. An antidepressant D. An opiate antagonist
C. An antidepressant Rationale: Some antidepressants have been shown to reduce the craving for nicotine and support smoking cessation programs. Benzodiazepines are used as anticonvulsants and to diminish anxiety during drug withdrawal. Antiseizure drugs are used to reduce and control seizures during drug withdrawal. Opiate antagonists are used to treat narcotic overdose.
The nurse is caring for a client with a substance use disorder. The client states to the nurse, "I really appreciate all of your care. Can we meet for a cup of coffee sometime?" Which statement made by the nurse provides the most therapeutic response? A. "When you have completed your treatment, we most certainly can meet for a cup of coffee." B. "I would love to meet you for a cup of coffee." C. "Thank you, but I will not be able to. It is important that we maintain a therapeutic relationship." D. "You are my client, and it is unethical for me to do that."
C. "Thank you, but I will not be able to. It is important that we maintain a therapeutic relationship." Rationale: Often, substance users have an unhealthy sense of personal boundaries and frequently cross them. Clinicians need to be aware of professional boundaries, which the client can violate or exploit. The statement that provides the most therapeutic response is, "Thank you, but I will not be able to. It is important that we maintain a therapeutic relationship." The statement acknowledges the client and reinforces the therapeutic boundaries. Telling the client, "I would love to meet you for a cup of coffee," is unethical and violates the professional boundaries. Stating to the client, "You are my client and it is unethical for me to do that," does not acknowledge the client's personal feelings. Stating to the client, "When you have completed your treatment, we most certainly can meet for a cup of coffee," promotes an ambiguous relationship that is not therapeutic for the client.
The nurse is teaching high school students about substance abuse. Which should the nurse include about the risk factors for becoming addicted to a substance? (Select all that apply.) A. Depression B. Peer pressure C. Poor social skill development in the child D. Family history of drug abuse E. Family involvement in child's life
A, B, C, D Rationale: Poor social skills, peer pressure, family history of substance abuse, and depression are all risk factors for developing a substance abuse problem. Family involvement in a child's life is not a risk factor; however, lack of family involvement is.
The emergency department nurse is providing care to a client who admits to substance abuse. Which physical symptoms should the nurse assess during the physical examination? (Select all that apply.) A. Inflamed nasal mucosa B. Poor nutritional status C. Staggering gait D. Dilated pupils E. Complaints of cough
A, B, C, D Rationale: Dilated pupils, poor nutritional status, inflamed nasal mucosa, and staggering gait may all be physical signs of substance abuse. Complaints of a cough are not a typical physical sign of substance abuse.
The nurse is caring for a pregnant client with a substance use disorder. Which substance type should the nurse expect to be treated with medication therapy? (Select all that apply.) A. Narcotic B. Nicotine C. Opioid D. Cocaine E. Alcohol
A, B, C, E Rationale: Alcohol, nicotine, and narcotics, including opioids, are substances that medication therapy is used to treat abuse. Medication therapy is not beneficial and would not be appropriate for an addiction to cocaine.
During a prenatal visit, a pregnant client admits to using cocaine at least once per day, and that getting cocaine is her highest priority. Which problem should the nurse make a priority for this client? A. Imbalanced Nutrition: Less than Body Requirements related to limited food intake B. Impaired Gas Exchange related to respiratory effects of substance abuse C. Risk for Infection related to drug use D. Activity Intolerance related to decreased tissue oxygenation
A Rationale: A person who abuses substances will spend money on drugs rather than food and other basic needs, which will lead to Imbalanced Nutrition: Less than Body Requirements related to limited food intake. Activity Intolerance related to decreased tissue oxygenation does not relate to cocaine use. Clients may have trouble sleeping or getting adequate rest from using cocaine. Risk for Infection related to drug use might be appropriate for cocaine use, but the question does not specify how cocaine is being used. Impaired Gas Exchange related to respiratory effects of substance abuse is inappropriate because it is a risk, not a current problem.
The nurse is assessing a client with a dependency on cocaine. Which cognitive manifestation should the nurse expect to assess in this client? (Select all that apply.) A. Pulls at clothes while fidgeting in the chair. B. Expresses feelings of anxiety. C. Appears overly happy despite the hospital admission. D. States sleeping all the time. E. Talks incessantly with rambling thought patterns.
A, B, C, E Rationale: Individuals who routinely use cocaine have symptoms of anxiety; demonstrate excessive talking that indicates rambling thought processes, elation, euphoria, and sometimes tactile hallucinations. Insomnia, not excessive sleeping, occurs in those who routinely use cocaine.
The nurse is caring for a client experiencing withdrawal from a central nervous system (CNS) depressant. Which collaborative treatment should the nurse expect to implement? (Select all that apply.) A. Using activated charcoal to absorb the drug B. Inducing vomiting C. Keeping the client awake D. Taking vital signs every hour E. Recommending group therapy
A, B, C Rationale: During withdrawal from CNS depressants, treatment includes keeping the client awake, inducing vomiting while employing aspiration precautions, and using activated charcoal to absorb the drug. Vital signs are taken more frequently than hourly and should be monitored every 15 minutes. Group therapy would be beneficial after the withdrawal of the substance.
The nurse in the employee health clinic knows that nurses are at high risk of developing substance abuse problems. Which should the nurse identify as a reason for this risk? (Select all that apply.) A. Frequent contact with drugs B. Pressures in the workplace C. Easy access to drugs D. Spending time with coworkers outside work E. Working 12-hour shifts
A, B, C Rationale: Easy access to drugs, pressures in the workplace, and frequent contact with drugs are reasons why nurses are at high risk of developing substance abuse problems. There is no correlation between nurses being at high risk of substance abuse and working 12-hour shifts or spending time with coworkers outside the workplace environment.
Which is a behavioral sign of substance abuse? (Select all that apply.) A. Suicidal gestures B. Poor hygiene C. Memory lapses D. Poor nutrition E. Mood swings
A, B, C, D Rationale: Behavioral signs of substance abuse include mood swings, memory lapses, poor hygiene, and suicidal gestures. Poor nutrition can result from prolonged substance abuse, but it is not an overt behavioral sign.
The nurse prepares a teaching tool about substance abuse in older adults. Which information should the nurse include? (Select all that apply.) A. Depression and alcohol abuse are disorders frequently found in clients who completed suicide. B. Individuals can have substance abuse problems at any age. C. Older women are more likely to use prescription medicines. D. Substance abuse is more likely to be recognized in older adults. E. Alcohol and other substances can make it difficult to diagnose medical problems
A, B, C, D Rationale: Individuals can have substance abuse problems at any age. Older women are more likely to use prescription medicines. Alcohol and other substances can make it difficult to diagnose medical problems. Depression and alcohol abuse are disorders frequently found in clients who completed suicides. Substance abuse is less likely to be recognized in older adults due to insufficient knowledge, lack of research, and hurried office visits.
The nurse is teaching a client who uses intravenous drugs about the potential for health problems. Which infectious bloodborne disease should the nurse include in this teaching? (Select all that apply.) A. Hepatitis C B. Hepatitis B C. AIDS D. HIV E. Tuberculosis
A, B, C, D Rationale: Intravenous (IV) drug use increases the exposure and transmission of certain infectious diseases, such as hepatitis B and C, and HIV/AIDS. Tuberculosis is not a bloodborne disease.
A client is being treated for glue inhalation. Which independent intervention should the nurse expect to implement? (Select all that apply.) A. Maintaining an accurate record of fluid intake and output B. Assigning the client to one nurse for therapeutic intervention C. Maintaining a quiet environment D. Administering an opioid antagonist intravenously E. Assessing the client's heart rate, respirations, and blood pressure
A, B, C, E Rationale: Inhalants can displace oxygen and cause tachycardia and respiratory depression. Assess for renal function because chemicals found in many glues can cause chronic renal damage. It is best to have a single nurse who talks to, calms, and reassures the client until the effects of the substance use subside. To calm the client, external stimuli should be reduced, with minimal sound, light, and activity. An opioid antagonist is not effective with the use of inhalants.
A client requiring a mandatory court-ordered drug testing is seen in the clinic. On which body tissue should the nurse conduct this testing? (Select all that apply.) A. Urine B. Hair C. Serum D. DNA E. Saliva
A, B, C, E Rationale: Mandatory drug tests may be done with a variety of diagnostic procedures, including testing on urine, saliva, serum, and hair. Genetic/DNA testing is unrelated to drug use.
The nurse is caring for a client with a history of substance abuse. Which statement should indicate to the nurse that the client is progressing through an effective course of recovery? (Select all that apply.) A. "I know I will always need to use the tools from the addiction program." B. "I've been back in school for the last two semesters." C. "I still like hanging with my old friends." D. "I don't think I really was addicted; I just went through a bad patch." E. "I haven't used drugs in over 2 years."
A, B, E Rationale: Statements that indicate abstinence, an awareness of addiction issues, and a return to normal functioning are indicative of recovery. Statements that use such ego defenses as denial and minimization are not signs of effective recovery.
The school nurse notices that the parents of two school-age children are not involved in their children's school activities. The children's maternal grandmother tells the nurse that the parents are recovering addicts. Which type of therapy might the nurse consider appropriate for this situation? (Select all that apply.) A. Family therapy B. Behavior therapy C. Occupational therapy D. Pharmacologic therapy E. Group therapy
A, B, E Rationale: The types of therapy that may be appropriate for this situation include family therapy, group therapy, and behavior therapy. Pharmacologic and occupational therapy are not indicated in this situation.
The nurse is teaching a class about stress reduction techniques in relation to substance abuse. Which should the nurse include in the lesson? (Select all that apply.) A. Effective coping skills B. Social drinking C. Meditation D. Abdominal breathing techniques E. Progressive muscle relaxation
A, C, D, E Rationale: Important teaching regarding substance abuse includes stress reduction. This may include a variety of techniques including imagery, meditation, muscle relaxation, breathing techniques, and effective coping skills. In substance abuse, alcohol should be avoided entirely, even in medications containing alcohol such as cough medicine.
Which is considered a curative factor in group therapy? (Select all that apply.) A. Group cohesiveness B. Individuation C. Universality D. Existential factors E. Altruism
A, C, D, E Rationale: Through the group process, clients recognize their altruism by understanding that they have something to give to the other group members. Cohesiveness occurs when members feel a sense of belonging. Through interaction with other group members, clients experience universality by realizing that they are not alone in their problems or pain. The group provides existential opportunities for clients to explore the meaning of their life and place in the world. Individuation, a developmental process of differentiation, is not a curative factor in group therapy.
A client is hospitalized for a substance abuse disorder. Which intervention should the nurse identify to promote safety for this client? (Select all that apply.) A. Encourage to verbalize fears. B. Obtain samples for drug analysis. C. Set limits to behavior. D. Obtain a drug history. E. Discuss coping skills.
A, E Rationale: Discussing coping skills and encouraging the client to verbalize fears are appropriate interventions for promoting healthy coping skills. Obtaining samples for drug analysis, setting limits to behavior, and obtaining a drug history do not pertain to the client's safety.
The nurse is caring for a client with alcohol addiction. The therapist on the treatment team has implemented a contingency contract. Which statement reflects the nurse's understanding of the use of a contingency contract? A. The client will be rewarded when meeting desired outcomes. B. It is an active solution that resolves emotional, cognitive, and behavioral problems. C. The client is taught how to regulate destructive emotions, practice mindfulness, and tolerate distress. D. It is a progressive weakening of an undesirable behavior through repeated nonreinforcement of the behavior.
A. The client will be rewarded when meeting desired outcomes. Rationale: A contingency contract may be an effective reinforcement process in which the client is rewarded when meeting desired outcomes. Rational emotive behavior therapy is an active solution that resolves emotional, cognitive, and behavioral problems. A progressive weakening of an undesirable behavior through repeated nonreinforcement of the behavior is the definition for the term extinction. Dialectical behavioral therapy is a type of therapy during which clients are taught how to regulate destructive emotions, practice mindfulness, and better tolerate distress.
Addiction v. Dependence
Addiction includes the physiological process of dependence, but also includes a psychological need that causes the addict to seek substance at any cost. (neglecting children, work, etc.)
When used as part of behavioral therapy for addictions, token economies function as a form of A) punishment. B) negative reinforcement. C) positive reinforcement. D) extinction.
Answer: C Explanation: A) Token economies are formalized programs in which clients who meet desired outcomes accrue a number of token rewards to exchange for privileges or activities. As such, they represent a form of positive reinforcement, or consequences that increase the likelihood of a particular behavior. In contrast, negative reinforcement involves removing a negative stimulus to increase the chances that a desired behavior will occur. Punishment involves applying negative consequences to cause a decrease in undesirable behavior. Extinction refers to the progressive weakening of an undesirable behavior through repeated nonreinforcement of the behavior.
An employee health nurse is providing care to a worker who was injured on the job. The client has a history of drug addiction and is currently enrolled in a 12-step recovery program. In order to determine whether the employee was impaired at the time of the accident, which diagnostic tool should the nurse use? A) Liver enzymes B) Stool guaiac C) Urine toxicology testing D) Hair testing
Answer: C Explanation: A) Urine toxicology testing will determine whether the employee had drugs in his system during the shift in which the injury occurred. Hair testing can detect substance use for up to 90 days and is not an accurate tool to determine whether the employee was impaired at the time of the injury. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood.
The nurse educator is discussing psychological theories of addiction with a student. What statement indicates that the student understands these psychological theories? A: "Family theory sees addiction as learned maladaptive behavior." B: "Personality theories see addiction as a result of negative reinforcement." C: "Behavior theory sees addiction as a result of family dysfunction." D: "Psychoanalytical theory sees addiction as a fixation at the oral developmental stage."
Answer: D
The nurse is caring for an adolescent client diagnosed with alcoholism. The client states he is frequently coerced by family to do things that cause feelings of unhappiness, such as turning over his entire paycheck or babysitting younger siblings. Which intervention might the nurse select to help the client develop new coping skills? A: Thought stopping B: Mindfulness training C: Pain management D: Assertiveness training
Answer: D
Which factor does not contribute to an adolescent's risk of substance abuse? A: Low self-esteem B: Peer pressure C: History of trauma D: Intelligence level
Answer: D
The nurse is providing care for a client who admits to alcohol addiction. The client states she is able to hide the addiction from family and friends. Based on this information, which independent nursing intervention is appropriate for this client? A) Assertiveness training B) Milieu therapy C) Family therapy D) Communication training
Answer: D Explanation: A) Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions that involve collaboration with therapists.
A client is admitted to the emergency department with signs of drug use. The client reports ingesting Percocet and is currently experiencing respiratory depression. Based on this information, which prescription should the nurse anticipate for this client? A) Diazepam B) Haldol C) Vitamin B12 D) Naloxone
Answer: D Explanation: A) Percocet (oxycodone and acetaminophen) is an opioid narcotic. Thus, the nurse should anticipate administration of naloxone (Narcan), because this medication is used in the treatment of narcotic overdose. Diazepam would be prescribed to manage the symptoms of substance withdrawal. Haldol would be administered to manage an overdose of phencyclidine (PCP). Vitamin B12 would be used to manage the neurologic symptoms that might accompany a nitrate overdose.
While practicing at an outpatient addiction clinic, the nurse summarizes a diagram in the orientation handbook for another nurse who is new to the clinic. That diagram is reproduced below. Which of the following statements on the part of the new nurse would reflect an appropriate understanding of this diagram? A) "Most abused substances either imitate or block the action of neurotransmitters." B) "In order to be addictive, a substance must cause the release of excess neurotransmitters." C) "Substances that exert antagonistic effects can be used to counteract the addictive tendencies of substances that exert agonistic effects." D) "People with addictive personalities process neurotransmitters differently than people who are less prone to addiction."
Answer: A Explanation: A) Most abused substances either mimic or block neurotransmitters at critical receptor sites. These drugs exert agonistic effects if they boost neurotransmitter synthesis, increase neurotransmitter release, or activate receptors that normally respond to neurotransmitters (as illustrated in the top half of the diagram). Conversely, they exert antagonistic effects if they interfere with neurotransmitter release, occupy receptor sites that are normally sensitive to neurotransmitters, or cause leakage of neurotransmitters from synaptic vesicles (as shown in the bottom half of the diagram). Both drugs with agonistic effects and those with antagonistic effects can be addictive, and administering one class of drug will not counteract the addictive tendencies of the other class. Researchers have not identified an addictive personality type.
A client with a history of alcohol abuse is being discharged to a treatment facility. Which prescription does the nurse anticipate for this client? A) Disulfiram B) Naloxone C) Bupropion hydrochloride D) Varenicline
Answer: A Explanation: A) Disulfiram (Antabuse) is an abstinence medication that would cause the client to become immediately and violently ill when consuming alcohol. Naloxone is administered to clients who overdose on opiates. Bupropion hydrochloride and varenicline are both medications that assist with smoking cessation.
A nurse is concerned about potential substance abuse by a coworker. Which of the coworker's behaviors would place the clients on the unit at risk for injury? A) The nurse in question frequently volunteers to give medications to clients. B) The nurse in question prefers not to be the "medication nurse" on the shift. C) The nurse in question declines to take scheduled breaks. D) The nurse in question frequently requests the largest client care assignment for the shift.
Answer: A Explanation: A) Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.
A nurse who runs an addiction treatment group at an inner-city clinic has noticed that many of the group's participants struggle with the stigma attached to their condition. Which of the following statements on the part of the nurse would best help participants overcome this stigma? A) "Relapse is a common feature of substance abuse." B) "Heredity and complex environmental influences predispose some people to substance dependence." C) "People who have an addiction problem cannot be held accountable for their actions." D) "Alcoholics Anonymous and Narcotics Anonymous are both accepted treatment approaches."
Answer: B Explanation: A) Many clients with addiction struggle with the stigma associated with their condition; for instance, they may feel that addiction is a form of moral failure or a result of personal weakness. Reassuring clients that addiction is rooted in a combination of heredity and environmental factors may help them overcome some of these false beliefs and move toward recovery. Although many clients with a history of substance abuse do relapse, this information would not help overcome the stigma of addiction, nor would information regarding Alcoholics Anonymous or Narcotics Anonymous. Nurses should strive to hold clients with addiction accountable for their actions; absolving them of responsibility only serves to enable their substance abuse.
A nurse is talking with the adult daughter of an 80-year-old client who was recently discovered to be abusing prescription narcotics. The daughter expresses frustration that this substance abuse wasn't discovered sooner, and she asks the nurse how her father's previous healthcare providers could have overlooked this problem. Which of the following statements would not be appropriate for the nurse to include in her reply? A) "Substance abuse and addiction are almost unheard of among older adults, so few providers would consider the possibility of these diagnoses when working with clients like your father." B) "Older adults often choose not to tell their providers about substance use because they either don't recognize they have a problem or don't feel they need treatment." C) "Diagnosis of substance abuse can be difficult in older clients because their symptoms sometimes mimic those of other disorders." D) "There is currently little research data on substance abuse in the older adult population, which means many providers are unaware of the actual extent of this problem."
Answer: A Explanation: A) Substance abuse in older adults is believed to be underestimated, underidentified, underdiagnosed, and undertreated. Until relatively recently, alcohol and prescription drug misuse was not discussed in either the substance abuse or the gerontologic literature. Insufficient knowledge, limited research data, and hurried office visits are cited as reasons why healthcare providers often overlook substance abuse and misuse in this population. Diagnosis is often difficult because symptoms of substance abuse in older individuals sometimes mimic symptoms of other medical and behavioral disorders common among older adults, such as diabetes, dementia, and depression. In addition, many older adults do not seek treatment for substance abuse because they do not feel they need it.
The nurse is conducting an assessment interview with a client who may be abusing substances. Which elements are important for the nurse to incorporate in the interview, if family members are to be included? Select all that apply. A: Respecting confidentiality B: Including family members C: Building trust D: Providing referrals E: Accepting all explanations
Answer: A, B, C
Which are considered curative factors in group therapy? Select all that apply. A: Group cohesiveness B: Existential factors C: Universality D: Altruism E: Individuation
Answer: A, B, C, D
Which considerations might interfere with a client revealing an addiction to a health care provider? Select all that apply. A: Fear of legal reprisal B: Contempt C: Embarrassment D: Shame E: Nurse-client relationship
Answer: A, B, C, D
A client with alcoholism is receiving court-ordered care in a residential treatment facility. After alcohol is discovered in her room, the client states, "It is not mine." Which responses by the nurse are appropriate in this situation? Select all that apply. A) "You will lose your day pass privileges for this Sunday." B) "We have a video of you accepting the alcohol from your brother." C) "What do you think about sharing this at AA tonight?" D) "You won't be allowed to go to dinner tonight." E) "You have violated our behavior contract."
Answer: A, B, C, E Explanation: A) Used with care and a calm attitude, confrontation interferes with the client's ability to use denial or rationalization. Losing privileges is an appropriate consequence for violating the behavior contract. Participation in AA will provide peer feedback and can help the client remain accountable for her behavior. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.
The school nurse notices that the parents of two school-age children are not involved in their children's school activities. The children's maternal grandmother tells the nurse that the parents are recovering addicts. Which type of therapy might the nurse consider appropriate for this situation? Select all that apply. A: Group therapy B: Family therapy C: Pharmacologic therapy D: Occupational therapy E: Behavior therapy
Answer: A, B, E
What are appropriate independent nursing interventions for a client diagnosed with an addiction? Select all that apply. A: Establishing a therapeutic relationship B: Providing care for presenting problem C: Promoting effective coping skills D: Prescribing a medication for symptom management E: Teaching communication skills
Answer: A, C, E
A client is concerned that her husband, who has a long history of alcoholism, is losing his memory and experiencing personality changes. Which disorder will the nurse educate this client about based on this information? A: Delirium tremens (DTs) B: Korsakoff syndrome C: Cirrhosis of the liver D: Alcohol poisoning
Answer: B
The nurse educator is discussing the chemistry of alcohol dependence with a group of students in the classroom environment. Which statement made by a student indicates correct understanding of the neurotransmitters involved in alcohol dependence? A: "A deficiency of acetylcholine creates a dependence on alcohol." B: "Dopamine and serotonin are involved in developing a dependence on alcohol." C: "Gamma-aminobutyric acid (GABA) is involved in alcohol dependence." D: "Excess glutamate creates a dependence on alcohol."
Answer: B
The nurse is conducting a support group for adolescent drug users. The nurse notes that one member is treating another member in the same critical way he treats his younger sister. Which group therapy concept does this observation demonstrate? A: Extinction B: Social microcosm C: Internalization D: Splitting
Answer: B
Which of the following terms refers to a physiologic need for a substance that the client cannot control and that results in withdrawal symptoms if the substance is withheld? A) Tolerance B) Dependence C) Addiction D) Codependence
Answer: B Explanation: A) Dependence is a physiologic need for a substance that the client cannot control and that results in withdrawal symptoms if the substance is stopped or withheld. Dependence causes the user to develop a physiologic tolerance for the substance, which means the user requires progressively greater quantities of the substance to achieve the same pleasurable effects. Addiction is a psychologic or physical need for a substance or process to the extent that the individual will risk negative consequences in an attempt to meet the need. Codependence is a cluster of maladaptive behaviors exhibited by the significant others of a substance-abusing individual that serves to enable and protect the abuse.
During visitation on the unit, a nurse is observing the family dynamics of an adolescent client who has an addiction problem. In doing so, the nurse concludes that the family is exhibiting codependence. Which of the following behaviors on the part of the family supports the nurse's conclusion? A) The family is intolerant of any frustration on the part of the client. B) The family engages in actions that enable the client's self-destructive behavior. C) The family is argumentative about seemingly insignificant issues. D) The family exhibits high levels of impatience.
Answer: B Explanation: A) Codependence is a cluster of maladaptive behaviors exhibited by the significant others of a substance-abusing individual that serve to protect and perpetuate the abuse. Codependence frequently involves enabling behavior, which is any action an individual takes that either consciously or unconsciously facilitates substance dependence. Although impatience, intolerance of frustration, and argumentative behaviors may also be present in this family, they are generally not related to the cycle of codependence and addiction.
The nurse is working with a client with a history of substance abuse. Which client statements indicate that the client is in recovery? Select all that apply. A: "I don't think I really was addicted; I just went through a bad patch." B: "I've been back in school for the last two semesters." C: "I haven't used drugs in over two years." D: "I know I'll always have to work the program." E: "I still like hanging with my old friends."
Answer: B, C, D
A nurse is conducting a community assessment as part of planning rehabilitation services for a recovering heroin addict. Which questions will the nurse include to gain information regarding available supports within the community? Select all that apply. A: Is there a college in the community? B: Are there any possible funding resources? C: What support groups are available in the community? D: Is there a community mental health center? E: Is there a rehabilitation center to help the client resolve addiction behavior issues?
Answer: B, C, D, E
The nurse is providing education to a client who admits to IV drug use. The nurse will provide education on which infectious diseases based on the client's history of drug use? Select all that apply. A: Tuberculosis B: HIV C: Hepatitis B D: Hepatitis C E: AIDS
Answer: B, C, D, E
The nurse is working with a client suffering from cocaine addiction. One intervention goal is to help the client develop more effective coping skills. What are some of the dysfunctional defenses typical of addicts that the nurse should help the client to address? Select all that apply. A: Sublimation B: Denial C: Rationalization D: Minimization E: Projection
Answer: B, C, D, E
The nurse is conducting a crisis assessment for a client who admits to cocaine use. Which questions are appropriate for the nurse to ask the client during this process? Select all that apply. A) "Do you have access to any recreational centers?" B) "What is the most significant problem affecting your life right now?" C) "How long has this been a problem?" D) "What are the living conditions in your neighborhood?" E) "What other stresses are you dealing with?"
Answer: B, C, E Explanation: A) When conducting a crisis assessment for a client who admits to using a substance that is associated with addiction, the nurse should ask about the most significant problem in the client's life right now, how long this problem has been occurring, and what other stresses may be affecting the client. Questions about recreational centers and neighborhood living conditions are more appropriate for a community crisis assessment than for an individual crisis assessment.
A nurse educator is teaching a group of students about the comprehensive theory of addiction proposed by George Engel. Which of the following student statements indicate proper understanding of this theory? Select all that apply. A) "Addiction occurs because of a lack of emotional attachment." B) "There is a biological factor involved in the development of addiction." C) "There are social factors that contribute to the development of addiction." D) "There is a moral factor involved in the development of addiction." E) "There are psychologic elements involved in the development of addiction."
Answer: B, C, E Explanation: A) George Engel is credited with proposing the biopsychosocial model of addiction. The biopsychosocial model is supported by current research and takes a more holistic view, theorizing that biological, psychologic, and social factors all contribute to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.
A client being seen for a routine checkup tells the nurse that her two children are doing poorly at school. She thinks that they might not be getting enough sleep because her husband frequently comes home late after drinking with his friends and wakes up the family. She doesn't want to say anything to him because "he works hard and needs to relax." Which behavior is the client exhibiting? A: Intervention B: Confrontation C: Codependence D: Collaboration
Answer: C
A community health nurse is providing teaching to the faculty of a local high school about preventing, recognizing, and treating substance use and addiction in teenagers. Which of the following statements on the part of the faculty members suggests that further teaching is necessary? A) "The earlier a teenager begins using substances, the more likely it is that the teenager will develop an addiction problem." B) "Teenagers whose parents suffer from addiction are at greater risk of addiction themselves." C) "The brain stops developing during the teenage years, so any substance-related brain changes that occur during this period will likely affect a person for the rest of his or her life." D) "Group therapy can be beneficial for teenagers with addiction, but it comes with a risk of unintended adverse effects."
Answer: C Explanation: A) The human brain continues developing well into a person's mid-20s. The relative immaturity of the adolescent brain helps explain why teenagers are more likely than adults to engage in thrill-seeking, high-risk behaviors such as substance use. Teenagers who start using substances early or who have parents who struggle with addiction are more likely to become addicted themselves. Group therapy can be a useful treatment method for teenage clients, but it must be led by a trained facilitator to ensure that group members don't steer conversation toward talk that glorifies or extols substance use.
A client has been admitted to a healthcare facility for treatment for substance addiction. Shortly after entering the facility, the client received a prescription for phenytoin. Based on this data, which of the following statements is most likely true? A) The client is addicted to opioids. B) The client is experiencing cravings for nicotine. C) The client has high levels of anxiety. D) The client is experiencing withdrawal-related seizure activity.
Answer: D Explanation: A) Phenytoin is an antiseizure medication that is used to reduce and control seizure activity resulting from withdrawal syndrome. Seizure activity may occur during withdrawal from several different categories of substances, including alcohol and benzodiazepines. Opioid withdrawal usually does not produce seizures. Clients who are experiencing nicotine cravings may receive nicotine replacement therapy and/or antidepressants, not phenytoin. Withdrawal-related anxiety may be treated with benzodiazepines, not antiseizure drugs.
What is enabling behavior?
Any action an individual takes that consciously or unconsciously facilitates substance dependence.
The nurse is caring for a client with an addiction to cocaine. Which medication should the nurse expect to be prescribed? (Select all that apply.) A. Opioids B. Dopamine agonists C. Antidepressants D. Antipsychotics E. Opioid antagonists
B, C Rationale: Pharmacologic treatment for cocaine abuse includes antidepressants and dopamine agonists. Opioids and opioid antagonists are pharmacologic treatment measures for opiates.
The nurse conducting a health history should consider which factor as a risk for substance use disorders? (Select all that apply.) A. Divorce B. Loneliness C. Family history D. Mental illness E. Low income
B, C, D Rationale: Mental illness, loneliness, and family history are risk factors that might predispose a client to develop a substance use disorder. Having a low income or being divorced does not predispose a client to developing a substance use disorder.
The nurse is conducting an assessment interview with a client who may be abusing substances. Which element should the nurse incorporate if family members are included? (Select all that apply.) A. Accepting all explanations B. Respecting confidentiality C. Building trust D. Including family members E. Providing referrals
B, C, D Rationale: Building trust, respecting confidentiality, and including family members in the assessment can help uncover hidden addiction problems. Accepting all explanations is not always useful in assessing substance abuse. Providing referrals is a nursing intervention, not an assessment activity.
The nurse suspects that a coworker has a substance use disorder. Which finding should the nurse use to confirm this suspicion? (Select all that apply.) A. Wears more makeup than other nurses. B. Breath smells like mouthwash. C. Frequently asks peers for breath mints. D. Wears long sleeves despite hot weather. E. Face is frequently flushed when indoors.
B, C, D, E Rationale: Potential signs of an impaired nurse include facial flushing; frequent use of breath mints, mouthwash, and perfumes; and wearing long sleeves despite hot weather to cover needle tracks on arms. Wearing makeup is not a warning sign of an impaired nurse.
The nurse is caring for a client withdrawing from the hallucinogen LSD. Which nonpharmacologic treatment should the nurse anticipate being used? (Select all that apply.) A. Conducting group therapy B. Ensuring low stimuli with minimal light, sound, and activity C. Speaking slowly and clearly to the client D. Recommending individual therapy E. Having one person reassure and "talk the client down"
B, C, E Rationale: During withdrawal from LSD, nonpharmacologic treatment includes speaking slowly and clearly to the client; ensuring low stimuli with minimal light, sound, and activity; and having one person reassure and "talk the client down." Individual and group therapy would be beneficial after the withdrawal of the substance.
Which independent nursing intervention is appropriate for a client diagnosed with an addiction? (Select all that apply.) A. Providing care for the presenting problem B. Establishing a therapeutic relationship C. Teaching communication skills D. Prescribing a medication for symptom management E. Promoting effective coping skills
B, C, E Rationale: Nursing interventions for clients with addictive behaviors include nursing care for any specific presenting symptoms, establishing a therapeutic relationship with appropriate boundaries, and promoting healthy client communication and coping skills. It is outside the scope of nursing practice to prescribe medications to a client. Providing care for the presenting problem is a collaborative intervention between the primary healthcare provider and the nurse. The nurse can administer medications per order but not prescribe them.
The nurse suspects that a nurse colleague is chemically impaired. Which behavior by the colleague warrants this concern? A. Staying on the unit after the shift is over B. Frequent trips into the client's room C. Infrequent breaks D. Client denial of having received pain medication
D. Client denial of having received pain medication Rationale: Healthcare providers are as susceptible as anyone else to developing substance abuse. By the very nature of their roles, nurses are in frequent contact with drugs and are at high risk for substance abuse problems. A warning sign of an impaired nurse in the workplace includes client denial of having received pain medication and frequent trips to the bathroom. Staying on the unit after the shift is over and frequent trips to the client's room are not observable warning signs of impairment.
Milieu Therapy
Creating a successful recovery environment that will support the addict's behavioral changes, teach new coping mechanisms, and help move from addiction to addiction free life.
The nurse is caring for an older adult suspected of having an alcohol addiction. What is the nurse's understanding of the reason many older adults will not seek treatment for substance abuse? A. They do not want anyone to know that they have a substance abuse problem. B. They prefer to avoid treatment because of their age. C. They do not understand the consequences of the abuse. D. They do not feel that they need help.
D. They do not feel that they need help. Rationale: Substance abuse in older adults is believed to be underestimated, underidentified, underdiagnosed, and undertreated. Many older adults will not seek treatment for substance abuse simply because they feel that they do not need help, not because they are older or do not understand the consequences or for fear of anyone finding out that they have a problem.
The preceptor is orienting a new nurse on an inpatient addiction unit. The new nurse states, "I am afraid I will say the wrong thing to a client." Which statement made by the preceptor will reinforce therapeutic communication skills of the new nurse? A. "When a client starts arguing with you, remind them that you are in charge of their care." B. "You can never say anything wrong. Clients with addictions will not notice." C. "If you are unsure what to say, deflect the conversation back to the client." D. "If you have any concerns with the client, use 'I' statements to describe them."
D. "If you have any concerns with the client, use 'I' statements to describe them." Rationale: Using the "I" statement to describe the concerns without singling out a client promotes therapeutic communication. The nurse must be mindful of verbal and nonverbal communication with any clients. Many individuals with addictions come from families with impaired communication, so it is important that communication be simple and direct. Deflecting is a defense mechanism. It is important that the nurse not argue or get angry with the client. Reminding a client that the nurse is in charge will create further discord.
What is the biopsychosocial model?
It is the most comprehensive theory for the process of addiction. Clinicians use this model as a foundation to link biological, genetic, psychological, emotional, and sociocultural factors contributing to the development of addiction. Many factors place an individual at risk for substance use, abuse, and dependence. No single cause can explain why one individual develops a pattern of drug use and another person does not.
Prevention
Often revolve around education.
Korsakoff psychosis
Secondary dementia caused by thiamine (B1) deficiency that may be associated with chronic alcoholism; characterized by progressive cognitive deterioration, confabulation, peripheral neuropathy and myopathy.
The nurse is conducting a community assessment as part of planning rehabilitation services for a recovering heroin addict. Which question should the nurse ask to gain information regarding available supports within the community? (Select all that apply.) A. "Is there a community mental health center?" B. "What support groups are available in the community?" C. "Is there a college in the community?" D. "Is there a rehabilitation center to help the client resolve addiction behavior issues?" E. "Are there any possible funding resources?"
A, B, D, E Rationale: A community assessment evaluates such resources to support recovery as mental health services, support groups, rehabilitation centers, and funding for local services. Although a college may be a community asset, it is not central to support for addiction recovery.
A client states, "I do not smoke, but I did binge drink a few times before I knew I was pregnant." Prior to teaching on substance use and abuse, what is the nurse's understanding of the effects of binge drinking on the fetus? A. Developmental delay B. Renal agenesis C. Sensory deficits D. Cardiac defects
A. Developmental delay Rationale: Alcohol is considered a teratogenic agent that interrupts development or can cause malformation in an embryo or fetus. Alcohol use can lead to developmental delay. Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders (FASDs) and other adverse birth outcomes, including developmental delay. Cardiac defects, sensory deficits, and renal agenesis are not common findings associated with alcohol use in pregnancy.
The nurse is discussing psychologic theories of addiction with a colleague. Which statement indicates that the colleague understands these psychologic theories? A. "Behavior theory sees addiction as a result of family dysfunction." B. "Psychoanalytic theory sees addiction as a fixation at the oral developmental stage." C. "Personality theories see addiction as a result of negative reinforcement." D. "Family theory sees addiction as learned maladaptive behavior."
B. "Psychoanalytic theory sees addiction as a fixation at the oral developmental stage." Rationale: Psychoanalytic theory sees addiction as a fixation at the oral developmental stage. Behavioral theory sees addiction as learned maladaptive behavior. Family theory sees addiction as a result of multigenerational dysfunctional family patterns. Some personality theories see addiction as a result of psychologic inadequacy.
The nurse is planning care for a pregnant client with a substance abuse disorder. Which intervention should the nurse identify to address imbalanced nutrition in this client? (Select all that apply.) A. Assess for signs of infection. B. Educate on negative effects of substances on body. C. Monitor meal intake. D. Educate on negative effects of substances on fetal health. E. Obtain daily weight.
C, E Rationale: Weighing the client and monitoring meal intake are appropriate interventions for a client with a nutritional deficit. Assessment of signs of infection would be appropriate for a risk for infection. The client has a potential for enhanced knowledge when educated on the effects of substance use on the body and on fetal health, but they are not related to nutrition imbalances.
The nurse is caring for a client experiencing confusion related to alcohol abuse. Which nutritional impairment has contributed to the client's decreased cognitive ability? A. Folate deficiency B. Vitamin B12 deficiency C. Niacin deficiency D. Vitamin B1 deficiency
D. Vitamin B1 deficiency Rationale: Clients who engage in any type of substance abuse are at risk for deficiencies in key nutrients. A vitamin B1 (thiamine) deficiency in the brain causes changes in cognition, especially confusion. Deficiencies in vitamin B3 (niacin), vitamin B9 (folate), and vitamin B12 (cobalamin) are not directly linked to decreased cognitive ability.
