Nicotine Addiction
A client asks the nurse about the effectiveness of hypnosis for smoking cessation. Which is the nurse's correct response? A) "Hypnosis works best when paired with a smoking cessation program." B) "Hypnosis is very effective." C) "Hypnosis never works for quitting." D) "Hypnosis sometimes works."
A) "Hypnosis works best when paired with a smoking cessation program." Rationale: Mixed results have been found in studies, perhaps due to the varying quality of the hypnotherapy. Therefore, it is recommended to pair hypnotherapy with other traditional smoking cessation programs.
The nurse is assessing a pregnant client who states that she smokes a pack of cigarettes each day. Which action by the nurse is the most appropriate? A) Assess the client's readiness to stop B) Ask if she would like a referral to a smoking cessation support group C) Do nothing; smoking is a personal decision D) Encourage the client to cut down to half a pack a day
A) Assess the client's readiness to stop Rationale: Before planning any intervention with a client who smokes, it is essential to determine whether or not the client is willing or ready to stop smoking. Smoking can be detrimental to fetal development and is related to increased rate of spontaneous abortion, increased incidence of placental abruption, being small for gestational age, and sudden infant death syndrome (SIDS). Informing the client of the risk factors and offering help with a referral to a support group provides encouragement, but it is the client's decision to quit. Commonly, women will stop smoking for the duration of the pregnancy, which gives the nurse an opportunity to work with the client to help with permanent smoking cessation. No action results in not providing adequate health promotion information.
The nurse is teaching clients about the health risks associated with nicotine addiction. Which condition should the nurse include? SATA A) Premature aging B) Degenerative disc disease C) Heart disease D) Graves disease E) Kaposi sarcoma
A, B, C, D Rationale: Nicotine addiction is associated with multiple health risks including heart disease, lung cancer, and chronic obstructive pulmonary disease. Cancers of the bladder, colon, and cervix have been linked to smoking. Graves disease, infertility, early menopause, dysmenorrhea, impotence, osteoporosis, and degenerative disc disease have also been associated with smoking. Other less serious consequences include discolored teeth and fingernails, premature aging and wrinkling, bad breath, reduced sense of smell and taste, strong smell of smoke clinging to hair and clothing, and gum disease. Recent studies have indicated a negative relationship between Kaposi sarcoma and nicotine use.
The community nurse is creating a resource tool kit for a public health website. Which of these organizations should the nurse link to for info on smoking cessation? SATA A) The American Lung Association B) The U.S. Surgeon General's website C) The American Heart Association D) The CDC E) The American Red Cross
A, B, C, D Rationale: The American Red Cross deals with disaster mitigation, not smoking cessation. The other organizations are good sources of information about smoking cessation.
The nurse is caring for a client who uses nicotine. Which clinical manifestation should the nurse anticipate when assessing the client? SATA A) Nervousness B) Burns on fingers C) Chronic cough D) Dry, chapped lips E) Shortness of breath on exertion
A, B, C, E Rationale: Assessment findings for nicotine use can include chronic cough, nervousness, burns on fingers, and shortness of breath on exertion. Lips are not dry and chapped as a result of nicotine use, but they can be discolored.
The school nurse is addressing parents about risk factors for children becoming addicted to nicotine. Which factor should be included? SATA A) Alcohol use B) Social Pressure C) Age D) Higher Education E) Emotions
A, B, C, E Rationale: Emotions, social pressure, alcohol use, and age are all risk factors associated with nicotine use. A lack of education, not higher education, is also associated with nicotine use.
The nurse develops a discharge plan for a client with COPD and a nicotine addiction. Which nursing intervention is appropriate for promoting smoking abstinence? SATA A) Teaching relaxation techniques B) Providing community resource information C) Assessing airway patency D) Assessing for injury E) Requesting a prescription order for smoking cessation medications
A, B, E Rationale: Consulting with the healthcare provider regarding the possibility of ordering smoking cessation medications, teaching relaxation techniques, and providing community resource information are all appropriate nursing interventions when promoting smoking abstinence. Assessing for injury and for airway patency does not promote abstinence.
The school nurse is seeking to reduce the rate of smoking among teens in the community. Which method should the nurse recognize as proving effective? SATA A) Increased taxes on cigarettes B) School-based tobacco-use prevention policies C) Celebrities shown smoking in movies D) Parent-led programs E) Counter-advertising mass media commercials
A, B, E Rationale: National, state, and local program activities that have reduced and prevented youth tobacco use in the past have included combinations of the following: counteradvertising mass media campaigns (such as TV and radio commercials); comprehensive school-based tobacco-use prevention policies and programs; and higher costs of tobacco products through increased excise taxes. Parent-based programs and showing celebrities glamorizing smoking in movies do not stop teens from smoking.
A nurse is caring for a client with congestive heart failure (CHF) who currently smokes cigarettes and had a 50 pack year smoking history. When providing smoking cessation education to this client, whcih statements regarding the pathophysiology of nicotine use are appropriate? SATA A) "In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine." B) "In high doses nicotine stimulates the parasympathetic system to release epinephrine, causing vasoconstriction." C) "Initially, nicotine increases mental alertness and cognitive ability." D) "Nicotine is a non-psychoactive substance found in tobacco." E) "Gradual reduction of nicotine intake appears to be the best method of cessation."
A, C Rationale: In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. This response is associated with the sympathetic nervous system, not the parasympathetic nervous system. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco. Gradual reduction in nicotine use seems to prolong the suffering of withdrawal and is not a recommended method of cessation.
Which drug and/or behavior should the nurse anticipate as a risk associated with the use of tobacco? SATA A) Cannabis B) Safe sex practices C) Cocaine D) Fighting with others E) Alcohol
A, C, D, E Rationale: Tobacco use has been associated with cannabis, alcohol, and cocaine use and with unprotected sexual activity and fighting with others, as well as other risky behaviors.
The nurse prepares a presentation to promote smoking cessation at an assisted living facility. Which condition should the nurse present as having an association with smoking? SATA A) Cataracts B) Retinal detachment C) Bone disease D) Stomach ulcers E) Diabetes complications
A, C, D, E Rationale: Smoking increases the risk of many types of cancers, especially cancers of the respiratory and gastrointestinal (GI) tracts. Smoking has also been linked to diseases other than cancer in older adults, including pulmonary and cardiovascular diseases, diabetes complications, bone disease, bone density loss, cataracts, and stomach ulcers. Smokers are up to 10 times more likely to get cancer than a person who has never smoked. However, it has not been linked to retinal detachment.
The nurse at a clinic prepares a class on the effects of secondhand smoke on children. Which condition shoult the nurse include? SATA A) Cancer B) Yellowing of the fingers C) Wrinkles in the skin D) Upper respiratory tract infections E) Otitis Media
A, D, E Rationale: Children exposed to secondhand smoke are at an increased risk of otitis media, upper respiratory tract infections, and cancer. Individuals who actually smoke are at risk for developing wrinkles in the skin and yellowing of the fingers. Next Question
Which body change should the nurse recognize as related to nicotine addiction? SATA A) Increase in BP B) Decrease in HR C) Decrease in BP D) Bronchitis E) Increase in HR
A, D, E Rationale: Use of nicotine causes vasoconstriction, which results in increased heart rate and blood pressure as well as peripheral vascular resistance, thereby increasing the workload of the heart. Long-term effects include hypertension, bronchitis, and possible lung cancer.
An 80-year-old client with heart disease tells the nurse, "I am sick because I sinned by smoking cigarettes." Which response by the nurse is appropriate? A) "Smoking cigarettes isn't a sin. There are many worse habits you could have." B) "Cigarette smoking was socially acceptable when you began smoking. People didn't fully understand the problems it could cause." C) "Why don't we call the hospital chaplain and you can pray about your sins?" D) "You are correct, but it's too late to do anything about it now."
B) "Cigarette smoking was socially acceptable when you began smoking. People didn't fully understand the problems it could cause." Rationale: This client is in distress and seeking forgiveness. The nurse should offer this forgiveness and a reason why the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that the client's distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking is a sin. Saying there are worse habits minimizes the client's concerns and does not offer forgiveness.
A client presents with a burn on the right index finger caused by falling asleep with a lit cigarette in hand. Additionally the client reports an inability to relax and insomnia and denies that smoking has negative effects on the body. Which is the priority nursing diagnosis when developing the plan of care? A) Anxiety B) Injury, Risk for C) Knowledge, Deficient D) Sleep Pattern, Disturbed
B) Injury, Risk for Rationale: njury, Risk for is the priority diagnosis. The client has a burn on the right index finger from falling asleep with a lit cigarette in the hand. Therefore, safety is a priority concern. The assessment findings also show the client has Anxiety (inability to relax), Sleep Pattern, Disturbed (complaints of insomnia), and Knowledge, Deficient (denial that smoking has negative effects on the body), but these are not the priority. (NANDA-I © 2014)
Why is smoking particularly dangerous for those with atherosclerosis? A) Smoking causes a direct increase in HDL cholesterol, which further contributes to plaque buildup B) Smoking causes vasoconstriction, which further impairs tissue oxygenation C) Smoking causes a direct increase in total cholesterol, which further contributes to plaque build up D) Smoking causes a decrease in blood pressure, which further impairs tissue oxygenation
B) Smoking causes vasoconstriction, which further impairs tissue oxygenation Rationale: Smoking does not directly affect cholesterol levels. However, it does lead to vasoconstriction and an increase in blood pressure, which further impairs tissue oxygenation in clients with atherosclerosis.
The nurse is teaching a class of adolescents about smoking. Which of the following points is most important to convey to this audience? A) Teens and young adults are not strongly influenced by tobacco advertising B) Smoking is a major cause of lung cancer C) Increasing the cost of cigarettes is not an effective deterrent to smoking D) Few young people who smoke regularly during their teen years continue to use tobacco as adults.
B) Smoking is a major cause of lung cancer Rationale: Smoking is a main cause of lung cancer, and it also directly contributes to the development of many other diseases, including heart disease and stroke. Teenagers and young adults tend to be strongly influenced by both tobacco advertising and counteradvertising mass media campaigns. Increasing the cost of cigarettes has been found to be an effective deterrent to smoking. Teenagers who smoke regularly tend to continue smoking during adulthood, which makes prevention particularly important among the adolescent population.
The nurse is incorporating yoga into a smoking cessation class. Which rationale explains the value of yoga for this class? A) Yoga influences nicotinic receptors in the brain B) Yoga reduces anxiety C) Yoga builds flexibility in the muscles D) Yoga increases awareness of spirtuality
B) Yoga reduces anxiety Rationale: Yoga reduces anxiety caused by the craving for nicotine during cessation. While it may build flexibility and raise spiritual awareness, that is not the purpose in this class. Yoga does not influence nicotinic receptors in the brain. OK
The public health nurse is preparing a presentation on nicotine addiction. Which nicotine replacement therapies (NRTs) should the nurse state are available over the counter? SATA A) Vaper B) Nicotine patch C) Nicotine gum D) Nicotine inhaler E) Nicotine spray
B, C Rationale: Nicotine patches and nicotine gum are available over the counter. Nicotine spray and nicotine inhalers require a prescription. Vapers are not NRTs. Researchers have yet to determine if vapers are safe or are simply less harmful than tobacco.
The nurse is creating a plan of care for a client undergoing treatment for nicotine addiction. Which expected outcome should the nurse consider appropriate? SATA A) The client denies the negative effects of nicotine on the body B) The client remains free from injury C) The client describes methods of coping without the use of nicotine D) The client voices benefits of starting a smoking cessation program E) The client maintains a patent airway
B, C, D, E Rationale: Expected outcomes for clients with nicotine addiction include a patent airway, freedom from injury, the ability to describe methods of coping without nicotine use, and the ability to voice benefits of smoking cessation programs. The client should also verbalize, not deny, the negative effects of nicotine on the body.
The nurse is providing care to a client who admits to smoking two packs of cigarettes per day for 34 years. The client also has a history of intermittent claudication, chronic bronchitis, and emphysema. After 6 weeks of smoking cessation, the client reports that he's frequently "yelling" at his spouse and "flying off the handle." Which effects of cigarette smoking are associated with the data the nurse has collected from the client? SATA A) Nicotine causes destruction of the alveoli B) Smoking triggers the release of epinephrine, which causes vasoconstriction C) Dopaminergic processes are implicated in nicotine withdrawal D) The tar in cigarettes can cause the mucus production seen in chronic bronchitis E) Tobacco use leads to atherosclerosis.
B, C, D, E Rationale: Nicotine causes the release of dopamine (a precursor to norepinephrine) and epinephrine. These substances trigger vasoconstriction, which exacerbates intermittent claudication. Tobacco use also causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis. Dopaminergic processes have a role in regulating the reinforcing effects of nicotine, making cessation difficult and contributing to withdrawal symptoms including nervousness, restlessness, irritability, impatience, and increased hostility.
Which therapy should the nurse recommend that demonstrates success in smoking cessation? SATA A) Phototherapy B) Acupuncture C) Nicotine gum D) Massage E) Yoga
B, C, D, E Rationale: Yoga and massage have been shown to reduce anxiety when withdrawing from nicotine. Acupuncture has been shown to improve the likelihood of quitting. Gum, with or without nicotine, can be used to give oral stimulation without cigarettes. No studies have been done to show phototherapy improves smoking cessation.
The clinic nurse assesses a pregnant client who has delayed seeking prenatal care. The client states she is addicted to nicotine and is inquiring about therapy. Which therapy should the nurse recommend as options for this client to consider? SATA A) Narcotics anonymous B) Medication therapy C) Group supportive therapy D) Detoxification E) Behavioral therapy
B, C, E Rationale: Behavioral therapy, group supportive therapy, and medication therapy are beneficial therapies in a client addicted to nicotine. Detoxification is not beneficial and would not be appropriate for the client addicted to nicotine. Nicotine is not a narcotic; therefore, a referral to Narcotics Anonymous would not benefit this client.
The nurse completed a health history on a client addicted to nicotine. Which info is needed when collecting info about past nicotine use? SATA A) Cost of nicotine use B) Frequency of nicotine use C) Brand of nicotine use D) Duration of nicotine use E) Amount of nicotine us
B, D, E Rationale: When obtaining a health history, it is important to collect information on past nicotine use, such as amount, frequency, and duration. The brand and the cost of nicotine used are not important factors when obtaining the health history. OK
The nurse is providing education to a client who wants to quit smoking. Which statements are appropriate for the nurse to include in the teaching session? SATA A) "There is no adverse risk if you choose to smoke while wearing a nicotine patch." B) "Buproprion (Zyban) is used to suppress the craving for tobacco." C) "A piece of nicotine gum should be chewed for 5 minutes of every waking hour, then held in the cheek." D) "Most people quit smoking several times before they're successful." E) "Alternative therapies can help reduce the stress that accompanies smoking cessation."
B, D, E Rationale: When teaching clients about smoking cessation, the nurse should emphasize that most people who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and may be a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9-12 times daily. The gum should be chewed several times to soften it, then held in the buccal space for at least 30 minutes to absorb the medication. A client who is wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, because they may help the client better deal with the stress that accompanies smoking cessation.
The nurse is providing care to a client with a history of COPD who wants help and info regarding nicotine addiction and ways to quit smoking. After the nurse has provided education regarding smoking cessation, whch client statement would indicate appropriate understanding of the information presented? A) "I will keep a pack of cigarettes in my closet in case I need it." B) "I will taper off smoking gradually." C) "I will chew sugar-free gum when I want a cigarette." D) "I will eat a snack when I'm feeling nervous."
C) "I will chew sugar-free gum when I want a cigarette." Rationale: When providing education regarding smoking cessation, it is important for the nurse to include adaptive coping mechanisms for the client to use during times of stress. Expressing the intention to use a healthy coping mechanism—such as chewing sugar-free gum—when the urge to smoke arises indicates appropriate understanding of the information presented. Tapering off smoking and keeping cigarettes close by are examples of behaviors that indicate the client is not wholly committed to cessation. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.
A nurse is caring for a client who smokes cigarettes and wants information about nicotine replacement therapy (NRT). Which statement is appropriate for the nurse to include in the teaching session? A) "OTC NRT products include transdermal patches, gums, nicotine inhalers, and nasal sprays." B) "NRT helps relieve the psychologic and physiologic effects of nicotine withdrawal." C) "NRT does not address addictive behavior." D) "Using NRT in conjunction with a smoking cessation program is no more effective than using NRT alone."
C) "NRT does not address addictive behavior." Rationale: Nicotine replacement therapy (NRT) does not address addictive behavior. Although it helps relieve some physiologic effects of nicotine withdrawal, it does not address the psychologic effects. Over-the-counter NRT products include transdermal patches and gums; nicotine inhalers and nasal sprays are available by prescription only. Using NRT in conjunction with a smoking cessation program is more effective than using NRT alone.
Which of the following characteristics would increase a client's risk of unpleasant side effects from nicotine replacement therapy (NRT)? A) Male gender B) Heavy smoking prior to starting NRT C) Low body weight D) History of failed attempts at smoking cessation
C) Low body weight Rationale: A potential issue with NRT is that some transdermal patches and gums are designed for heavy smokers and may contain too large of a dose of nicotine. If clients have low body weight or did not smoke heavily prior to starting NRT, they may experience unpleasant side effects from ingesting too much nicotine. Male gender and a history of failed attempts at smoking cessation do not increase the risk of side effects. B) A potential issue with NRT is that some transdermal patches
A nurse works at a clinic that provides care to a community with a high population of smokers. The nurse is planning an educational session entitled, "Tips for Quitting." Which action by the nurse is appropriate for inclusion in this session? A) Telling participants that smoking is an unacceptable behavior B) Making sure participants are aware of the increased risk of liver disease and esophageal cancer associated with smoking C) Reviewing available pharmacologic adjuncts to cessation with participants D) Recommending that participants seek hypnosis at a local dinner theater to aid in their attempts at smoking cessation
C) Reviewing available pharmacologic adjuncts to cessation with participants Rationale: The nurse should include information about available pharmacologic adjuncts to cessation in a "Tips for Quitting" session. Simply telling the participants that smoking is unacceptable is not effective in promoting wellness. Although it is true that smoking contributes to cancer and liver disease, this information will not help participants identify and apply effective strategies for tobacco cessation. Hypnosis can be useful for clients who are trying to quit smoking, but the nurse should recommend that clients seek hypnosis only from a trained healthcare professional.
Which of the following statements is true with regard to vaping? A) Vaping is a safe alternative to cigarette smoking B) E-cigarettes are less popular among teens than cigarettes and other traditional tobacco products C) Vaping has been linked to a devastating respiratory illness known as "popcorn lung" D) Throughout the United States, vaping is subject to the same regulations as cigarette smoking
C) Vaping has been linked to a devastating respiratory illness known as "popcorn lung." Rationale: It remains to be proven whether e-cigarettes are actually safe or simply less harmful than tobacco. In many parts of the United States, vaping is unregulated. The popularity of e-cigarettes is exploding among teenagers and young adults; in 2014, e-cigarette use surpassed current use of every other tobacco product overall. Flavored e-cigarettes frequently contain diacetyl, a chemical that causes the debilitating respiratory disease bronchiolitis obliterans, also known as "popcorn lung."
A nurse is teaching a client about the effects of smoking during pregnancy. Upon conclusion of the teaching session, which of the following client statements would suggest that further education is necessary? A) "When a pregnant woman smokes, the concentration of nicotine in the fetus can be even higher than that in the woman's own body." B) "Smoking during pregnancy is associated with an increased risk of placental problems." C) "Prenatal nicotine exposure is linked to attention deficits and learning difficulties during childhood." D) "Although women who smoke during pregnancy are at a higher risk for respiratory disease later in life, their children are not."
D) "Although women who smoke during pregnancy are at a higher risk for respiratory disease later in life, their children are not." Rationale: Nicotine crosses the placenta, and fetal concentrations of nicotine can be 15% higher than maternal concentrations. Smoking during pregnancy is associated with increased risk for spontaneous abortion, preterm delivery, respiratory disease, immune system difficulties, and cancer later in life. Various studies link placental complications to prenatal exposure to cigarette smoke. Prenatal tobacco exposure has been associated with serious neurodevelopmental and behavioral consequences in children, including attention deficits and issues with learning and memory.
A nurse who works in an outpatient primary care clinic is caring for a client with asthma who has an 80 pack year history. When assessing the client's current use of nicotine, which question is most appropriate? A) "Have you tried a nicotine patch for quitting smoking?" B) "Do you smoke cigarettes with or without filters?" C) "Do you smoke immediately after waking up?" D)" What prior attempts have you made to quit using nicotine?"
D) "What prior attempts have you made to quit using nicotine?" Rationale: Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. Of the choices provided, only "What prior attempts have you made to quit using nicotine?" meets these criteria.
The nurse is planning crae for a client with esophageal cancer caused by years of nicotine abuse. Which of the following would be the priority nursing diagnosis for this client? A) Decisional Conflict B) Social Isolation C) Disturbed Body Image D) Ineffective Airway Clearance
D) Ineffective Airway Clearance Rationale: The nurse should anticipate that a client with esophageal cancer related to tobacco use may have issues with airway edema. Because proper breathing and oxygenation are crucial, Ineffective Airway Clearance would be the highest priority nursing diagnosis of the options listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.
The nurse assess a client with a nicotine addiction who is irritable, has not slept much lately, and has burns on his clothes. When developing a plan of care, the nurse identifies, Injury, Risk for as the priority nursing diagnosis. Which is the appropriate goal for this client based on the assigned diagnosis? A) The client will not experience complications B) The client will verbalize strategies for smoking cessation C) The client will demonstrate relaxation D) The client will remain free from injury
D) The client will remain free from injury Rationale: Remaining free of injury is a goal appropriate for the diagnosis of Injury, Risk for. Demonstrating relaxation, verbalizing strategies for smoking cessation, and avoiding complications are all appropriate goals based on the assessment findings, but not related to the priority diagnosis identified by the nurse. (NANDA-I © 2014)
