Exam 4 summer

The school nurse gives a presentation on tobacco use and prevention to a group of students. Which student statement indicates an understanding of the prevention information?

"Adolescence appears to be the primary time in which individuals initiate the use of tobacco."

A high school nurse is teaching a group of teenagers on common factors that may influence an individual to smoke. Which student statement indicates the need for further teaching?

"Age has nothing to do with someone choosing to smoke."

The nurse prepares to assess a patient with a history of methamphetamine abuse. Which question should the nurse use to build trust with the patient?

"How often and how much do you usually use?"

The patient is preparing to leave the smoking cessation class. Which statement by a participant indicates the need for further teaching?

"I can go out with my friends who smoke, but I will leave my cigarettes at home."

A patient is experiencing visual hallucinations during alcohol withdrawal. The patient is visibly upset and fearful. Which nursing statement best supports the patient?

"I see that you are scared. I do not see what you describe, but I will stay with you in the room."

The nurse is discussing the chemistry of alcohol dependence with a colleague. Which statement indicates the correct understanding of the neurotransmitters involved in alcohol dependence?

"Low levels of dopamine and serotonin are involved in alcohol dependence."

Nicotine *The nurse in the obstetrician's office wants to encourage a pregnant patient to stop smoking. Which is an appropriate statement by the nurse?

"Smoking during pregnancy can harm your fetus and have effects on the child during infancy, childhood, and adolescence."

The nurse is assessing a patient with a nicotine addiction who has tried multiple times to quit. Which question by the nurse is least therapeutic?

"Smoking is bad for your health. Do you want to quit smoking?"

During the health teaching session for patients addicted to nicotine, a participant asks about ways to prevent fingernails and fingers from turning yellow. Which response by the nurse is appropriate?

"Stop smoking."

The nurse is caring for a prenatal patient who has smoked for the past 12 years and is having difficulty quitting. Which is an appropriate statement by the nurse?

"There is medication therapy you may want to speak to your doctor about."

The nurse reviews common symptoms of substance withdrawal with colleagues. Which statement by the nurse about the symptoms of hallucinogen withdrawal is accurate?

"There is no specific pattern of symptoms in hallucinogen withdrawal."

The nurse is teaching patients and their families about substance use. Which statement should be included about withdrawal symptoms of hallucinogens?

"There is no specific pattern of withdrawal."

A patient who takes medication for chronic back pain becomes offended when asked about dependency on the medication. Which response should the nurse make to this patient?

"Use of medications for chronic pain puts you at risk of substance use disorders."

A patient with severe anxiety develops a pattern of using alcohol to help with symptom control. After 1 month of treatment in an outpatient setting, the patient is returning home. The nurse is completing the evaluation phase of the nursing process with the patient. Which patient statement supports an expected outcome?

"When I get anxious, I will ensure that I am not in an environment where alcohol is available."

The nurse is caring for a patient with an amphetamine addiction. Which withdrawal symptom should the nurse anticipate in the patient?

Disorientation *Withdrawal symptoms from amphetamines include the following: Fatigue Depression Agitation Apathy Anxiety Sleepiness Disorientation Lethargy Craving

The nurse is preparing a presentation on the pathophysiology of substance abuse. Which neurotransmitter most influences feelings of pleasure?

Dopamine

*The nurse is preparing a lesson on the pathophysiology of nicotine addiction. Which substances should the nurse state are released when nicotine stimulates nicotinic receptors?

Dopamine and norepinephrine

A patient presents with symptoms of upper gastrointestinal bleeding. Routine blood work and a blood alcohol level (BAL) are completed. Which other laboratory data may direct the nurse to suspect the patient has chronic alcoholism?

Elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT)

While conducting a health history on a pregnant patient, the nurse assesses for past substance abuse. Which intervention should be the nurse's priority?

Establish trust through therapeutic communication

The nurse prepares a smoking cessation program at a local community center. Which type of addiction treatment is the nurse likely to exclude from the program presentation?

Family therapy *Medication therapy, behavior therapy, and support groups are common interventions for smoking cessation and are appropriate to include in the program presentation

The nurse is teaching a pregnant patient about teratogens. Which element should the nurse explain as being safe in pregnancy?

Folic acid

The school health nurse is completing an assessment of alcohol use at a rural high school for grades 8-12. Which grade would be impacted the most by a preventive teaching intervention based on the nurse's knowledge of the average age at which young people drink?

Grade 8

The nurse cares for patients in a clinic that conducts drug testing. Which body part or fluid should the nurse expect to collect as a specimen for these tests?

Hair *Items that may be tested for drugs include urine, blood, saliva, hair, and perspiration. Substances can be detected in hair for up to 90 days.

*The community nurse wants to decrease smoking in the community. Which factor has encouraged cigarette smoking?

Having actors smoke on television shows *Decreasing the incidences of actors who smoke on television has helped in decreasing public acceptance of smoking. So have labeling negative effects on cigarette packages, banning smoking in public places, and increasing the cost of cigarettes.

The nurse is teaching a patient who is addicted to nicotine about nonpharmacologic treatments. Which treatment should the nurse suggest?

Hypnosis *Hypnosis is a nonpharmacologic method used in the treatment of nicotine use. The nicotine patch, chemotherapy, and nicotine spray are all pharmacologic methods.

The nurse is developing a plan of care for a patient addicted to opiates. Which intervention should the nurse make a priority for this patient?

Maintaining respiratory function

A patient who uses heroin asks about treatment to stop using the drug. Which therapy should the nurse understand to be beneficial for this patient?

Medication therapy

A patient seeks treatment for an addiction to opioids. Which medication should the nurse expect to be prescribed for this patient?

Methadone

Substance Use A patient seeks treatment for an addiction to opioids. Which medication should the nurse expect to be prescribed for this patient?

Methadone

*The nurse is teaching a patient addicted to nicotine about pharmacologic treatments. Which treatment should the nurse suggest?

Nicotine gum

The nurse in a substance use treatment clinic is administering methadone. For which substance should the nurse understand that methadone is used to treat withdrawal?

Opioids

*A patient is experiencing alcohol withdrawal delirium (delirium tremens). The nurse administers a benzodiazepine. No seizure activity is noted. Which nursing intervention will promote patient comfort and safety at this time?

Providing an environment that protects the patient and others

The nurse is caring for a patient who reports smoking for 15 years. After assessment, the nurse identifies Airway Clearance, Ineffective as a priority nursing diagnosis. Which nursing intervention is related to this diagnosis?

Providing humidified air *Possible nursing diagnoses for the smoker include the following: Injury, Risk for Denial, Ineffective Coping, Ineffective Airway Clearance, Ineffective Anxiety

A patient with a history of cocaine use seeks medical attention for a health problem. Which behavior should indicate to the nurse that the patient has recently used cocaine?

Rapid speech *Manifestations of cocaine use include rapid speech, euphoria, and potentially violent behavior. Lethargy, runny nose, and slurred speech are not symptoms of using this substance.

The nurse is discouraged that despite teaching numerous smoking cessation classes, only about one in four patients is able to quit smoking while treated with nicotine replacement therapy (NRT). Which is the best course of action for the nurse?

Recognize this is the national average and continue to educate the public, pairing NRT with counseling

The nurse is admitting a patient who reports he has been a smoker for 25 years. While planning care, the nurse identifies Injury, Risk for as a nursing diagnosis. Which intervention is most appropriate for this diagnosis?

Removing any smoking items the patient may have

A patient is participating in a community-based social detoxification program with limited medical oversight for alcohol withdrawal. The nurse completes a visit to the site to assess the patient.Which assessment finding should prompt the nurse to notify the healthcare provider and consider moving the patient to an acute care setting?

Report of a seizure *Outpatient programs operate on protocols for individuals with mild to moderate withdrawal symptoms and no serious psychiatric or medical comorbidities. Tachycardia and seizures would be considered as severe withdrawal symptoms and would require medical attention and support

The nurse is assessing a patient with a history of opiate abuse. Which manifestation should the nurse expect to assess in the patient?

Respiratory depression

The friend of a patient who was brought to the emergency department reports that the patient has used an unknown opiate. Which assessment finding should the nurse expect?

Respiratory rate of 10 breaths/min

A patient has started hypnotherapy as a means to stop smoking. Which therapy should the nurse recommend to increase the likeliness of success?

Smoking cessation program

During an admission assessment, a patient self-reports an addiction to opiates. Which screening tool should the nurse use when trying to determine the extent of the patient's physical dependence?

Subjective Opiate Withdrawal Scale (SOWS)

The nurse is implementing the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) for a patient experiencing acute alcohol withdrawal. The nurse asks if the patient has any itching, pins-and-needles sensations, burning, or numbness. Which component of the CIWA-Ar is the nurse testing?

Tactile disturbances

The nurse is preparing a presentation on substance use disorders for a group of community members. Which sociocultural etiological factor should the nurse identify that affects substance use disorders?

The individual's family approves of substance use.

*A patient is admitted to an ambulatory care unit after a minor surgical procedure. The nurse identifies that the patient may be experiencing mild alcohol withdrawal. Which symptom would support this assessment finding?

The patient is irritable and anxious. *Mild alcohol withdrawal generally consists of anxiety, irritability, difficulty sleeping, or decreased appetite. Hyperthermia and seizures are signs of acute alcohol withdrawal syndrome.

A patient with a BMI of 31 is brought to the emergency department for cocaine abuse. Which outcome should the nurse identify for this patient?

The patient will experience no cardiac event and respond to a dopamine agonist. *Patients who have taken cocaine may be given antipsychotics and are managed for the following: Hyperpyrexia Convulsions Respiratory distress Cardiovascular shock Acidic urine

The nurse is setting goals with a patient who has a substance use disorder. Which long-term goal should the nurse identify with this patient?

The patient will regularly attend a support group to maintain sobriety from substance use.

*A patient with Wernicke encephalopathy is admitted with altered consciousness. Which collaborative intervention should be implemented first for this patient?

Thiamine *It is common to use thiamine, oxygen, and dextrose to treat Wernicke encephalopathy in patients with an altered level of consciousness. It is preferred to give thiamine IV/IM first, then dextrose. It is also likely the patient will require supplemental oxygen. It is important to note that dextrose should be given after thiamine administration. The benzodiazepine would be given later to the stabilized patient to prevent seizures from alcohol withdrawal;

The nurse educator is preparing a presentation on the pathophysiology of nicotine use. Which receptors in the central nervous system (CNS) should the nurse identify that nicotine can occupy?

Acetylcholine

Alcohol A patient diagnosed with severe acute alcohol withdrawal is experiencing hyperthermia, sweating, and vomiting. Which nursing intervention would provide the patient with adequate hydration?

Administering IV therapy as per the healthcare provider's directive

The nurse performs a survey on smoking habits of older adult patients in an assistive living residence. Which is an expected outcome of such a survey?

Almost half of the patients smoked at one time, but less than 10% smoke now.

*The nurse assesses a patient with pneumonia who reports smoking tobacco for 15 years. Which immediate consideration should the nurse include in the physical?

Assess for presence of chronic cough and shortness of breath *When assessing patients who use nicotine, it is important to assess for amount and frequency of use, as well as the length of time nicotine has been used. The presence of any symptoms indicating possible complications such as a chronic cough, shortness of breath, hypertension, chest pain, or unexpected symptoms also need to checked.

The nurse is teaching patients with a history of substance abuse about setting goals for treatment. Which should be the nurse's first step?

Assess the patient's level of knowledge and readiness to learn the effects of drugs on the body.

The community nurse is sharing resources for smoking cessation. Which therapy would not be appropriate for the nurse to recommend?

Aversion therapy

*A 76-year-old patient is visiting the local health clinic. The nurse notes the patient is slightly confused and has an ataxic gait, slurred speech, poor hygiene, and smells of alcohol. Which disease condition should the nurse recognize that may mimic a substance abuse disorder in the patient?

Dementia *Diagnosis of alcohol abuse in an older adult is often difficult because symptoms of substance abuse may sometimes mimic other medical or behavioral disorders such as diabetes, dementia, and depression.

The patient tells the nurse he only drinks alcohol twice a month in large quantities when out with friends The nurse associates this behavior with which type of alcohol consumption?

Binge drinking *Binge drinking is a type of alcohol dependence in which the individual drinks a large quantity of alcohol in one session. Social drinking is not a pattern of dependence. Alcohol dependence results in the craving of alcohol when not drinking, physiological symptoms of withdrawal, and tolerance to alcohol.

A patient is concerned about having problems with drinking. He discloses to the nurse about having intense cravings for alcohol and often starts drinking after breakfast. Which tool is used to determine whether a patient has a problem with alcohol that may require treatment?

CAGE questionnaire

*Which clinical manifestation of nicotine addiction requires immediate intervention by the nurse?

Chest pain *Chest pain is a clinical manifestation of nicotine addiction that requires immediate intervention. COPD, chronic hypercapnia, and a chronic cough do not require immediate intervention by the nurse.

A patient with a history of substance abuse who is being treated for a self-inflicted injury is talkative, euphoric, and reports not sleeping for 2 days. Which substance use should the nurse suspect from these symptoms?

Cocaine

The nurse is caring for a patient admitted with alcohol dependence. The patient's family identifies significant neurologic changes in the patient over the past 2 months. The patient has lived with chronic alcoholism for 35 years. During assessment which symptom should the nurse recognize as characteristic of Korsakoff psychosis ?

Confabulation *Confabulation, making up information to fill in memory gaps, is a characteristic of Korsakoff psychosis, a chronic neuropsychiatric syndrome characterized by behavioral abnormalities and memory impairments. Ataxia and abnormal eye movements are characteristics associated with Wernicke encephalopathy. Anuria is not associated with Korsakoff psychosis or Wernicke encephalopathy.

The manager suspects that a staff member has a substance abuse disorder. Which action should the manager take?

Confront the nurse

*An 80-year-old patient presents with signs of alcohol intoxication. The patient's daughter cares for him and is concerned because her father has only one drink each evening. Which item, if found in the patient's belongings, would prompt the nurse to ask more questions?

Cough syrup

A patient who abuses inhalants becomes extremely agitated after a visit from family members. Which intervention should the nurse use to decrease the patient's agitation?

Dimming the lights

The nurse prepares a teaching plan for a pregnant patient with a history of substance abuse. Which topic should the nurse not include in the teaching plan?

Importance of checking blood glucose

The police bring a patient to the emergency department after a motor vehicle crash. The patient's blood alcohol level (BAL) is 0.23%. Which symptom of alcohol intoxication is demonstrated at a BAL of 0.20% to 0.25%?

Inability to remain upright *Clumsiness, ataxia, and dysarthria are symptoms experienced at a BAL of 0.10%. Additional Learning Clinical manifestations of alcohol abuse include: Being unable to limit the amount of alcohol consumed. Trying to decrease the amount consumed with variable success. Spending a lot of time drinking, getting alcohol, or recovering from alcohol use. Feeling a strong craving or urge to drink alcohol. Failing to fulfill major obligations at work, school, or home due to repeated alcohol use. Continuing to drink alcohol, even when it causes physical, social, or interpersonal problems. Giving up or reducing social and work activities and hobbies. Using alcohol in situations where it is not safe, such as when driving or swimming.

The nurse is teaching patients who wish to quit smoking tobacco. Which benefit of smoking cessation should the nurse include?

Increase in energy

*The nurse prepares a presentation on the fetal and neonatal effects of cocaine. Which effect of cocaine on the fetus and newborn should the nurse present?

Increased risk of sudden infant death syndrome (SIDS)

A patient with a long-term history of alcohol abuse and dependence is admitted to an inpatient unit. Which dietary recommendation should the nurse make?

Increasing dietary thiamine

The nurse is teaching a group of pregnant women about the effect of substance use on the fetus. Which complication should be included for marijuana use?

Intrauterine growth restriction

*A patient has completed detoxification from alcohol and is entering a day rehab program. The nurse administers IV naltrexone (ReVia, Depade), an opioid antagonist. Which is the purpose of this medication?

It reduces the patient's craving for alcohol.

A patient is concerned that her husband, who has a long history of alcoholism, is losing his memory and experiencing personality changes. Which disorder is the highest priority for teaching based on the information provided by the patient?

Korsakoff syndrome *It is important to note that Korsakoff psychosis and Wernicke encephalopathy often combine to cause Wernicke-Korsakoff syndrome. Wernicke encephalopathy is an acute life-threatening neurocognitive disorder characterized by the classic triad of symptoms: encephalopathy, ataxic gait, and some type of oculomotor dysfunction. Manifestations may include: Ocular abnormalities. Gait disturbances. Mental health changes. Double vision. Ataxia. Korsakoff psychosis is a chronic neuropsychiatric syndrome that develops over time. It is characterized by: Behavioral abnormalities. Anterograde and retrograde amnesia. Confusion. Confabulation (making up information to fill in memory blanks). Wernicke encephalopathy is considered a medical emergency. Prompt treatment with thiamine IM/IV can correct ocular and gait disturbances and prevent progression of the neurologic deficits.