Pharmacology Chapter 17 Substance Abuse

What is the goal of treatment for an individual with a long history of alcoholism? 1 Controlled social drinking of alcohol 2 Complete abstinence from alcohol use 3 Recognition of the reasons for drinking alcohol 4 Systematic substitution of cross-tolerant substances

2 Alcoholism is a disease and lasts a lifetime. Total abstinence is the goal. A person who has a long history of alcoholism cannot be treated by applying controlled social drinking. Recognition of the reasons for drinking alcohol cannot be an end goal. Systematic substitution of cross-tolerant substances is not relevant.

As a nurse escorts a discharged patient from an alcohol treatment center, which comment would be most therapeutic? 1 "I hope you've learned how to manage your drinking." 2 "Do not drink anymore. Alcohol is destroying your liver." 3 "I hope you can stay sober from now on and get back to work soon." 4 "Members of Alcoholics Anonymous will welcome you to meetings."

4 It is important to encourage attendance at Alcoholics Anonymous meetings, where the patient will receive ongoing support to maintain sobriety. Saying that alcohol is destroying the patient's liver or being judgmental about her drinking might make the patient apprehensive. Reminding the patient to be sober might not help the patient.

A patient who is a chronic smoker is being treated at a rehabilitation center. What will the nurse expect to administer to cease immediate cigarette craving in the patient? 1 Bupropion 2 Varenicline 3 Nicotine patch 4 Nicotine chewing gum

4 To provide quick relief from withdrawal or from cigarette craving, a gum is useful because it rapidly releases its dose of nicotine. The dose can be decreased slowly to reduce cigarette craving gradually. Bupropion is a nicotine-free drug that is useful in treating excess intake of nicotine. It does not give immediate relief from cigarette craving. Varenicline antagonizes and to some extent activates the nicotine receptors, but an immediate effect is not seen. A transdermal nicotine patch is useful for slow and stepwise reduction of nicotine intake.

What is characteristic of drug tolerance? 1 Need for increased doses of a drug to get the desired effect 2 Experience of indicators of withdrawal when the drug is stopped 3 Feeling an intense subjective need or craving for a particular drug 4 Dependence on another drug because of effects of the primary drug

1 Tolerance, which results from regular drug use, is defined as a state in which a particular dose of drug elicits a smaller response than it did with initial use. As tolerance increases, higher and higher doses are needed to elicit the desired effect. Withdrawal symptoms occur when any drug is stopped. In case of psychological dependence, the patient feels an intense subjective need or craving for a particular drug. Dependence on another drug because of effects of the primary drug is not a factor for drug tolerance.

A patient at an alcohol rehabilitation center has a flushed face and is vomiting. Which antialcoholic therapy has the patient undergone? 1 Disulfiram 2 Naltrexone 3 Alprazolam 4 Acamprosate

1 A flushed face, nausea, and vomiting are signs of acetaldehyde syndrome, which is caused by disulfiram therapy. Naltrexone, alprazolam, and acamprosate do not interfere with acetaldehyde metabolism. Acamprosate and alprazolam are useful for patients withdrawing from alcohol. Naltrexone is an opioid antagonist. It is also used in the treatment of alcohol addiction.

The nurse is assessing a patient with severe alcohol withdrawal. Which severe symptoms of withdrawal should the nurse monitor in the patient? Select all that apply. 1 Body temperature 103° F 2 Pulse rate 145 beats per minute 3 Systolic blood pressure 220 mm Hg 4 Diastolic blood pressure 100 mm Hg 5 Respiratory rate 6 breaths per minute

1, 2, 3 The symptoms of severe alcohol withdrawal are temperature above 101° F, systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, and pulse rate higher than 140 beats per minute. Therefore the nurse should monitor the temperature of 103° F, pulse rate of 145 beats per minute, and systolic blood pressure of 220 mm Hg. A diastolic blood pressure of 100 mm Hg is a symptom of moderate alcohol withdrawal. A respiratory rate of 6 breaths per minute is indicative of respiratory depression. This sign is associated with alcohol toxicity and not withdrawal.

A nurse is assessing a patient who underwent treatment for attention deficit disorder. The nurse concludes that the patient is experiencing hypersomnia, suicidal thoughts, and hyperphagia. Withdrawal from which medication does the nurse suspect is the cause of this condition? 1 Meperidine 2 Naltrexone 3 Amphetamine 4 Diacetylmorphine

3 Central nervous system stimulants, such as amphetamines, are used for the treatment of attention deficit disorder. The withdrawal of amphetamines causes hypersomnia, suicidal thoughts, and hyperphagia. Meperidine is used for the treatment of acute pain. Naltrexone is an opioid antagonist used to treat opioid abuse or dependence. Diacetylmorphine is used for the treatment of cough and diarrhea.

During a surgery, a patient received diazepam to aid with anesthesia. Which drug may the nurse administer to the patient after the surgery to reverse the sedative effect of the diazepam? 1 Clonidine 2 Naltrexone 3 Flumazenil 4 Acamprosate

3 Flumazenil is a benzodiazepine antagonist. It can be administered to reverse the sedative effect of benzodiazepines. Clonidine is given to patients with symptoms of opioid withdrawal. Naltrexone is an opioid antagonist that is useful in case of opioid abuse. It reverses the effects produced by opioid drugs. Acamprosate helps to maintain abstinence from alcohol. Therefore clonidine, naltrexone, and acamprosate cannot be given to reverse the sedative effect of diazepam.

Which drug creates a sleepy, relaxed, drunken feeling in patients? 1 Naloxone 2 Meperidine 3 Flunitrazepam 4 Methamphetamine

3 Flunitrazepam is benzodiazepine depressant commonly called a roofie, because it makes the person sleepy and relaxed. It is used for the treatment of insomnia in more than 60 countries, but is banned in the United States. Patients feel sleepy and drunken after consuming this drug. Naloxone is an opioid antagonist used for treating opioid abuse. Meperidine is an opioid used in the treatment of pain. Methamphetamine is a stimulant drug used for treating disorders such as narcolepsy.

Varenicline is prescribed for a middle-aged patient for smoking cessation. What is the priority nursing action for this patient? 1 Monitoring the patient for increased temperature 2 Monitoring every 4 hours for orthostatic hypotension 3 Telling the patient that nausea and vomiting are likely 4 Teaching the patient to avoid sunlight while on the medication

3 Nausea and vomiting are likely with this drug. Hyperthermia and orthostatic hypotension are not a concern with this drug. Avoidance of sunlight is not necessary while on this medication.

Following an assessment, the nurse finds that a patient who is an alcoholic is having tremors, and the blood pressure is 200/140 mm Hg. The nurse observes that the patient is also agitated. Which drug does the nurse expect to be prescribed for this patient? 1 Bupropion 2 Disulfiram 3 Alprazolam 4 Methamphetamine

3 The patient is suffering from severe alcohol withdrawal. Alprazolam is the treatment of choice for alcohol withdrawal symptoms; the dose depends on the severity of the condition. Bupropion is a drug used for smoking cessation in patients; it cannot be used for treating alcohol withdrawal symptoms. Disulfiram is used for decreasing the alcohol consumption by the patient. It is useful for severe alcoholics. It cannot be used as a treatment for alcohol withdrawal. Methamphetamine is a central nervous system stimulant and is not used for treating alcohol withdrawal.

The nurse is caring for a patient who has been using marijuana for a long time. Which complication, as a result of adverse effects of marijuana, does the nurse expect in the patient? 1 Chronic renal failure 2 Chronic liver failure 3 Chronic heart failure 4 Chronic respiratory failure

4 Long-term use of marijuana results in chronic respiratory symptoms because it is usually smoked. Chronic use of marijuana could lead to obstructive lung disease. This could further progress to respiratory failure. Marijuana has no adverse effect on the kidneys or liver, so it does not result in renal or liver failure. Smoking marijuana increases the heart rate but it does not lead to chronic heart failure.

What screening tool does the nurse use to assess an adolescent for possible substance abuse? 1 CAGE-AID Questionnaire 2 Michigan Alcoholism Screening Test (MAST-G) 3 Substance Abuse Subtle Screening Inventory (SASSI) 4 Problem-Oriented Screening Instrument for Teenagers (POSIT

4 The POSIT is an assessment tool used for screening substance abuse in teenage children. The CAGE-AID Questionnaire is useful for determining alcohol and other drug abuse. MAST-G is used to screen geriatric patients, and SASSI is used to screen adults.

Which supplements are given to a patient who has severe alcohol withdrawal syndrome? Select all that apply. 1 Iron 2 Calcium 3 Dextrose 4 Thiamine 5 Magnesium

4, 5 High temperature and elevated blood pressure are the common signs of alcohol withdrawal. Therefore to maintain normal body temperature and stabilize blood pressure, patients are supplemented with the amino acids thiamine and magnesium based on the severity of the withdrawal symptoms. Iron supplements are given to patients with conditions such as anemia. Calcium supplements are given to treat bone disorders. Dextrose is given in patients as a part of fluid replacement. Topics

Which manifestations are seen in a person who smokes marijuana? Select all that apply. 1 Anorexia 2 Tachycardia 3 Hypersomnia 4 Unsteady gait 5 Mild euphoria 6 Hallucinations

2, 4, 5, 6 The effects of marijuana use include tachycardia resulting from sympathetic stimulation, unsteadiness, euphoria, and hallucinations caused by stimulation of cannabinoid receptors. Hypersomnia and anorexia are side effects of stimulant withdrawal.

The nurse is caring for a patient admitted to the hospital with chest pain. The patient has a long-standing history of alcohol abuse. The nurse recognizes the need to monitor the patient for which adverse effects of chronic alcohol use? Select all that apply. 1 Tremors 2 Agitation 3 Bradycardia 4 Hypertension 5 Hypothermia

1, 2, 4 Symptoms of acute alcohol withdrawal include increased blood pressure, increased pulse, increased temperature, tremors, insomnia, and agitation. Bradycardia and hypothermia are not adverse effects of chronic alcohol use.

A patient who is a drug addict tells the nurse, "I get a better kick if I smoke the drug compared with when I swallow it." Which drug does the nurse expect the patient to be abusing? 1 Powdered cocaine 2 Crystallized cocaine 3 Powdered methamphetamine 4 Crystallized methamphetamine

4 Crystallized methamphetamine is the drug that is smoked and is more powerful than powdered methamphetamine. Cocaine is usually found in powdered form or sometimes crystallized form and is either snorted or injected intravenously. Powdered methamphetamine is administered either by snorting or injecting the drug.

In order to help prevent liver failure in a patient who drinks alcohol frequently, which drug will the nurse instruct the patient to avoid? 1 Acetaminophen 2 Methamphetamine 3 Any antianxiety agent 4 Any antihypertensive drug

1 Taking acetaminophen when a serum alcohol level is present causes alterations in the metabolism of these substances, leading to the formation of toxic byproducts, as well as decreased drug clearance and an increased risk of serious liver damage and death. Methamphetamine is form of amphetamine, and it is a commonly abused substance. Although antianxiety agents do not cause liver failure when taken with alcohol, the nurse should instruct the patient who drinks alcohol frequently to avoid antianxiety agents as a means of preventing enhancement of the central nervous system depression that is characteristic of both agents. Antihypertensive drugs reduce blood pressure.

Which medication is used by the nurse to help reduce an individual's craving for alcohol? 1 Naltrexone 2 Disulfiram 3 Methadone 4 Acamprosate

1 Naltrexone is a pure opioid antagonist that reduces the craving for alcohol and blocks its pleasurable effects. Disulfiram is used to prevent alcohol consumption, methadone is used to help reduce dependence on opioids, and acamprosate is used to maintain alcohol abstinence.

A patient comes to the emergency department complaining of severe back pain and asks for "something to take the pain away." Nursing assessment findings include mydriasis, rhinorrhea, diaphoresis, lacrimation, blood pressure 160/84 mm Hg, heart rate 116 beats/min, and respiratory rate 24 breaths/min. Which condition would the nurse suspect? 1 Opioid withdrawal 2 Barbiturate overdose 3 Ethanol intoxication 4 Amphetamine overdose

1 Signs and symptoms associated with acute opioid withdrawal include drug-seeking behavior, mydriasis, piloerection, diaphoresis, rhinorrhea, lacrimation, diarrhea, insomnia, and elevated blood pressure and pulse. Nurses in the emergency department must be alert for this behavior in patients seeking medication for subjective pain complaints, especially when accompanied by withdrawal symptoms.

A patient in the emergency department is experiencing tremors, agitation, and insomnia. The medical history reveals that the patient is being treated for alcoholism. After assessment, the patient was found to have a systolic blood pressure of 210 mm Hg, a diastolic blood pressure of 150 mm Hg, a pulse rate of 160 beats/min, and body temperature of 104° F. Which interventions does the nurse implement in this situation? Select all that apply. 1 Applying restraints 2 Administering oral disulfiram 3 Providing doses of acamprosate 4 Providing thiamine supplementation 5 Administering intravenous benzodiazepine

1, 4, 5 Tremors, agitation, and insomnia are the symptoms of ethanol withdrawal, which can be mild, moderate, or severe. The patient has a systolic blood pressure of 210 mm Hg, a diastolic blood pressure of 150 mm Hg, a pulse rate 160 beats/min, and a temperature of 104° F, which indicates severe alcohol withdrawal, known as delirium tremens. In this condition, if the patient is agitated or confused, applying restraints will help protect him and also protect others. Thiamine supplementation is provided to the patient to maintain the nutritional status. When alcohol withdrawal is severe, intravenous benzodiazepine is administered to relieve the symptoms of alcohol withdrawal. Oral disulfiram and acamprosate are given to patients who abuse alcohol.

A patient with attention deficit hyperactivity disorder who receives amphetamine therapy has accidentally consumed an excess dose of amphetamine. Which type of medication will the nurse expect to administer? 1 An opioid 2 A sedative 3 An analgesic 4 A depressant

2 Amphetamine is a central nervous system stimulant that, when taken in excess quantity, may cause adverse effects such as anxiety, insomnia, delirium, and hallucinations. The immediate action to be taken in this case is to sedate the patient. Sedatives are used specifically to induce sleep in the patient. Administering an opioid may not treat the condition of the patient, because the main therapeutic effect of an opioid is to relieve pain. Analgesics are used to relieve pain. Depressant drugs are used to treat anxiety, irritability, and tension. They may cause mild sedation, but are not intended to treat a stimulant overdose.

A nurse is assessing a patient and finds that she has increased psychomotor activity, agitation, and tremors of the eyelids, tongue, and hands. Which intervention does the nurse expect to be beneficial to the patient? 1 Administering clonidine 2 Administering diazepam 3 Administering bupropion 4 Administering varenicline

2 Increased psychomotor activity; agitation; and tremors of the eyelids, tongue, and hands are symptoms of depressant withdrawal. Diazepam is a benzodiazepine, which is used to reduce psychomotor activity; agitation; tremors of the eyelids, tongue, and hands; euphoria; suicidal thoughts; and hallucinations. Clonidine is given for opioid withdrawal. Bupropion and varenicline are administered as nicotine withdrawal therapies.

The nurse is teaching a class of school-age children about drug abuse prevention. Which topic is most important to include? 1 Cocaine 2 Inhalants 3 Barbiturates 4 Amphetamines

2 Inhalants are readily accessible and cheap. They are a drug of choice for children and adolescents. Cocaine, barbiturates, and amphetamines are medicines, and they are difficult to obtain.

Which medication is most suitable for a patient with alcohol addiction and opioid dependence? 1 Naloxone 2 Naltrexone 3 Levallorphan 4 Buprenorphine

2 Naltrexone is an opioid antagonist drug that can reduce the cravings for alcohol. Therefore it is approved for patients affected by alcohol addiction. Other opioid antagonists such as naloxone, levallorphan, and buprenorphine are also opioid antagonists but are not useful for alcohol-addicted patients. These medications do not reduce cravings for alcohol.

A patient with symptoms of nicotine withdrawal has been prescribed 21 mg of nicotine, to be taken every 24 hours. What is the recommended duration of the drug therapy for providing effective treatment? 1 2 to 4 weeks 2 4 to 8 weeks 3 6 to 12 weeks 4 4 to 12 weeks

2 Nicotine is used to treat symptoms of nicotine withdrawal. For effective treatment, 21 mg of nicotine can be administered for 4 to 8 weeks once per day. A dose of 7 mg/24 hr of nicotine must be used for 2 to 4 weeks. With the Nicotrol inhaler, 10 mg/inhalation must be used for 6 to 12 weeks. A dose of 15 mg/16 hr of nicotine is used for 4 to 12 weeks.

An adolescent's parents report to the nurse that the adolescent who was bright and motivated has become sullen and withdrawn in the past year. The parents also report that the adolescent has had a cough for a year. Which drug abuse does the nurse suspect in the adolescent? 1 Nicotine 2 Marijuana 3 Naltrexone 4 Methamphetamine

2 Sullen and withdrawn behavior is associated with depressant drug abuse, and the adolescent also has chronic cough. This indicates that the adolescent is smoking. Based on these observations, it is most likely that the adolescent is using marijuana, which is a depressant drug and is taken by smoking. Nicotine also causes chronic cough when taken via cigarettes, but is a central nervous system stimulant drug. Naltrexone is an opioid used to reduce alcohol cravings, and it does not cause a person to become sullen and withdrawn. Methamphetamine is a stimulant that causes increased alertness and reduces fatigue, not sullen and withdrawn behavior.

The nurse is assessing a patient who is prescribed clonidine therapy for opioid withdrawal. After the assessment, the nurse informs the primary health care provider that the patient cannot be administered clonidine immediately. Which assessment finding caused the nurse to make this suggestion to the health care provider? 1 Nausea 2 Excess pain 3 Hypotension 4 A low heart rate

3 Clonidine is an opioid antagonist drug that is commonly prescribed for opioid withdrawal. The drug is strictly contraindicated if the patient has low blood pressure, because it further reduces blood pressure. Nausea is a symptom associated with opioid withdrawal. Clonidine is administered to relieve the symptoms related to opioid withdrawal, such as nausea. This drug does not interfere with pain perception. A patient with pain can be administered this drug. Clonidine does not interact with the electrical activity of the heart. Therefore low heart rate is not a contraindication for this drug.

The nurse is assessing a patient who has involuntary muscle contractions and sleep disturbance. On reviewing the patient's prescription, the nurse finds that the patient has to be administered 20 mg of diazepam on day 1 and tapered to 5 mg by day 7 of the treatment. What would be the probable reason for giving such a prescription? 1 The patient has symptoms of acute stress disorder. 2 The patient has withdrawal symptoms of barbiturates. 3 The patient has withdrawal symptoms of benzodiazepines. 4 The patient has symptoms of posttraumatic stress disorder.

3 Involuntary muscle contractions and sleep disturbance are the symptoms of benzodiazepine withdrawal. For the treatment of these symptoms, the patient must be administered 20 mg of diazepam orally for 7 to 14 days. If the patient had barbiturate withdrawal symptoms, then the barbiturates would be given for 7 days, with the dose gradually reduced. Posttraumatic stress disorder and acute stress disorder are characterized by restlessness and insomnia. The treatment is continued until the patient is free from the symptoms. The dose should not be gradually reduced until 7 days.

The nurse is caring for a patient who has been prescribed warfarin for cerebral transient ischemic attack. The nurse suggests the patient drink a small amount of alcohol daily. What would be the reason for this suggestion? 1 Alcohol increases the elimination of warfarin. 2 Alcohol increases the metabolism of warfarin. 3 Alcohol increases the bioavailability of warfarin. 4 Alcohol shows the disulfiram reaction with warfarin.

3 Warfarin, a blood-thinning agent, is used to prevent blood clots and thereby decrease the risk of cerebral transient ischemic attacks. Alcohol consumption increases the bioavailability of warfarin. Therefore it further helps to decrease the risk of blood clots. A small amount of alcohol does not have any effect on the elimination or metabolism of warfarin. Alcohol does not show any disulfiram reaction with warfarin. Interaction of alcohol with metronidazole results in disulfiram reaction.

What is the third dosage of a transdermal patch (4 to 8 weeks) for a patient on nicotine withdrawal therapy? 1 7 mg/24 hr 2 11 mg/24 hr 3 14 mg/24 hr 4 21 mg/24 hr

4 A patient who is on transdermal nicotine withdrawal therapy is provided 21 mg/24 hr as the third dose. For the Nicoderm patch, 7 mg/24 hr is given as the first dose, and for the Prostep transdermal patch, 11 mg/24 hr is prescribed as the first dose. A second dose of 14 mg/24 hr of Nicoderm is prescribed for a chronic smoker.

Although a patient denies alcohol abuse and dependence, the nurse encourages treatment. According to the nurse, what should be the first step of the patient to make the rehabilitation successful? 1 Change his psychosocial network in the community. 2 Understand the effects of alcohol on all body systems. 3 Form partnerships with reliable sources of psychosocial support. 4 Recognize the relationship between life's problems and the use of alcohol.

4 Denial is the most commonly used defense mechanism for persons with substance abuse and dependence. Rehabilitation cannot begin until the individual accepts that a disease exists. Forming partnerships with reliable sources of psychosocial support and psychosocial networking are phases of rehabilitation. Understanding the effects of alcohol might not help the patient because the patient is in a stage of denial.

The nurse is caring for a patient with a history of alcoholism who is undergoing long-term alcohol treatment. Which intervention is the highest priority? 1 Administering propranolol daily 2 Teaching the patient about flumazenil 3 Monitoring the patient with methadone administration 4 Ensuring the patient knows to avoid alcohol when taking disulfiram

4 In addition to cognitive-behavioral therapy, disulfiram may be ordered because it prevents alcohol consumption by causing an unpleasant reaction if alcohol is taken. Propranolol, an adrenergic beta blocker, is indicated in treating elevated blood pressure and tachycardia, which may occur with amphetamine toxicity. Flumazenil is a benzodiazepine antagonist and is used to treat benzodiazepine overdose. Methadone is an opioid agonist used during opioid detoxification to decrease symptoms and is used in the long-term management of opioid addiction.

An adult with a long history of multiple hospitalizations for alcohol withdrawal is brought to the emergency department. The physician orders daily administration of thiamine. What is the rationale for this order? 1 To restore nutritional balance 2 To prevent alcoholic hepatitis 3 To suppress pancreatic enzymes 4 To prevent Wernicke encephalopathy

4 Thiamine deficiencies are common in persons who abuse alcohol; they can be life threatening. Wernicke encephalopathy is one form of thiamine deficiency. Thiamine administration does not restore nutritional balance, prevent alcoholic hepatitis, or suppress pancreatic enzymes.

A patient who consumed high doses of a benzodiazepine under the effect of alcohol is admitted to the emergency department. On assessment, the patient is found to be lethargic and unable to speak. Which actions by the nurse will prevent further complications? Select all that apply. 1 Provide hydration. 2 Administer naloxone. 3 Administer flumazenil. 4 Provide mechanical ventilation. 5 Provide magnesium replacement therapy

3, 4 An overdose of benzodiazepines ingested with alcohol is lethal. A patient would become lethargic and unable to speak as a result of respiratory distress. In this condition, a nurse should administer flumazenil because it reverses the action of benzodiazepines by directly competing with them for binding at benzodiazepine-binding receptors. The nurse should also prepare the patient for mechanical ventilation. Hydration is recommended in patients who have ethanol withdrawal. Naloxone is administered to patients who suffer from opioid abuse. Magnesium replacement therapy is useful for patients who have alcohol withdrawal.

After reviewing the medical history of a patient with anxiety, the nurse learns that the patient has been taking flunitrazepam while living abroad. The nurse immediately alerts the health care provider, who tells the patient to stop taking the drug. What health condition would be a contraindication for this drug? 1 Diabetes 2 Paralytic ileus 3 Tourette's syndrome 4 Narrow-angle glaucoma

4 Flunitrazepam, commonly called a roofie, is an intermediate-acting benzodiazepine drug. The drug is not approved in the United States, but is prescribed for anxiety in more than 60 countries. The drug is contraindicated in patients with narrow-angle glaucoma, however, so the primary health care provider would stop administration of this drug immediately. Flunitrazepam does not cause diabetes, paralytic ileus, or Tourette's syndrome. Central nervous system stimulants are contraindicated in patients with diabetes and Tourette's syndrome. Opioids are contraindicated in patients with paralytic ileus.

A chronic alcoholic patient is diagnosed with Wernicke encephalopathy. Which food should the nurse add in the diet chart of the patient? 1 Food rich in vitamin A 2 Food rich in vitamin D 3 Food rich in vitamin C 4 Food rich in B vitamins

4 Wernicke encephalopathy is caused by a deficiency of B vitamins. Alcohol reduces the absorption of vitamin B. Thus the nurse should add food that is rich in B vitamins to the patient's diet chart. Deficiencies of vitamins A, D, and C do not cause Wernicke encephalopathy. Moreover, alcohol does not affect the absorption of these vitamins.

The nurse is assessing a patient's history of substance abuse on admission to inpatient rehabilitation. The patient informs the nurse that he has been increasing his drug dosage to get the same effect. What is the patient experiencing? 1 Addiction 2 Tolerance 3 Habituation 4 Physical dependence

2 Tolerance is defined as requiring an increased amount of drug in the system to have the same desired effect. Habituation is the development of tolerance to a substance following prolonged medical use but without psychologic or physical dependence (addiction). Addiction is the psychologic or physical dependence on a drug or psychoactive substance. Physical dependence is a condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated.

A nurse is caring for a patient who received morphine for acute pain after knee replacement surgery. After stopping the morphine therapy, the physical assessment of the patient reveals nausea, dysphoria, lacrimation, and piloerection. Further assessment reveals the patient's increased desire to ingest opioids. Which medication does the nurse expect to be beneficial to the patient? Select all that apply. 1 Vivitrol 2 Diazepam 3 Clonidine 4 Bupropion 5 Methadone

3, 5

The nurse is assessing a patient who has been administered anesthesia. The nurse finds that the patient has difficulty breathing. Which drug does the nurse anticipate to be administered to the patient to provide relief from breathing difficulty? 1 Diazepam 2 Dobutamine 3 Phenobarbital 4 Amphetamine

4 Amphetamine is a central nervous system stimulant. A patient who is administered anesthesia may have difficulty breathing due to respiratory depression. To prevent discomfort and provide relief from breathing difficulty, amphetamine must be administered to the patient. Adrenergic drugs such as dobutamine may cause vasoconstriction, but may not help prevent respiratory depression. Barbiturates such as phenobarbital and benzodiazepines such as diazepam are central nervous system depressants. Therefore they should not be administered because they aggravate respiratory depression.

The primary care provider prescribes morphine to a patient who has undergone an appendectomy. While assessing the patient, the nurse finds that the patient's blood pressure is 100/60 mm Hg. The patient reports constipation, dizziness, and a severe headache. Which other signs and symptoms does the nurse expect to observe in the patient? Select all that apply. 1 Miosis 2 Diuresis 3 Pruritus 4 Tremors 5 Delirium

1, 2, 3 Morphine is an opioid drug that is used to treat acute pain. Blood pressure of 100/60 mm Hg indicates hypotension. Hypotension and constipation are side effects of opioid drugs caused by the release of histamine. The release of histamine also causes pruritus. Miosis and diuresis are the central nervous system (CNS) side effects of opioids. Tremors and delirium are the side effects of central nervous system stimulants such as amphetamines.

The nurse is assessing a patient who is hospitalized due to abrupt cessation of alcohol consumption. Which vital signs are consistent with the patient's condition? 1 Blood pressure 120/80 mm Hg, pulse rate 75, temperature 98.6° F (37° C) 2 Blood pressure 210/150 mm Hg, pulse rate 140, temperature 104° F (40° C) 3 Blood pressure 150/90 mm Hg, pulse rate 110, temperature 100° F (38.3° C) 4 Blood pressure 170/100 mm Hg, pulse rate 130, temperature 100° F (37.7° C)

2 A patient who has abruptly stopped consuming alcohol shows severe withdrawal symptoms, that is, a blood pressure higher than 200/140 mm Hg, pulse higher than 140, and temperature above 101° F (38.3° C). Thus in this situation, the vital signs of the patient could be blood pressure of 210/150 mm Hg, pulse rate of 140, and temperature of 104° F (40° C). If the patient's blood pressure is 120/80 mm Hg, pulse rate is 75, and temperature is 98.6° F (37° C) then the patient would be normal in terms of alcohol withdrawal. If the patient has blood pressure 150/90 mm Hg, pulse rate 110, and temperature 100° F (38.3° C) then mild withdrawal of alcohol is present. If the patient has blood pressure 170/100 mm Hg, pulse rate 130, and temperature 100° F (37.7° C), then she is displaying moderate alcohol withdrawal.

The nurse assesses a patient who was receiving treatment for narcolepsy. Which signs will the nurse monitor in the patient? Select all that apply. 1 Rhinorrhea 2 Lacrimation 3 Hyperphagia 4 Hyperthermia 5 Paranoid delusions

3, 5 Narcolepsy is episodes of acute sleepiness. Stimulants are used to treat the condition. Thus the nurse has to monitor the signs of stimulant withdrawal, such as hyperphagia and paranoid delusions. The other signs, such as rhinorrhea, lacrimation, and hyperthermia, are not associated with stimulant withdrawal. Rhinorrhea and lacrimation are the signs of opioid withdrawal. Hyperthermia is a sign of depressant withdrawal.

A patient reports craving cigarettes, irritability, and restlessness. On assessment, a nurse finds that the patient has a decreased heart rate and blood pressure. Which medication does the nurse expect to be beneficial for the patient? 1 Clonidine 2 Flumazenil 3 Naltrexone 4 Varenicline

4 Cigarette cravings, irritability, restlessness, and decreased heart rate and blood pressure indicate nicotine withdrawal. Varenicline is a medication that binds with high affinity at α4β2 neuronal nicotinic acetylcholine receptors, thereby facilitating smoking cessation. Clonidine is a centrally acting alpha agonist used for patients who have opioid withdrawal. Flumazenil is a benzodiazepine reversal agent that is used to treat opioid withdrawal. Naltrexone is an opioid antagonist used for patients who have opioid withdrawal.