psych ch 58

Which of the following medications are used as an alcohol deterrent?

Disulfirum (Antabuse) Disulfiram (Antabuse) is a drug given to people recovering from alcoholism who cannot control the compulsion to drink.

Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine?

Dopamine

There are several reasons why drug therapy is of limited use in treating substance dependence. Which of the following statements accurately describes a potentially serious risk of such therapy?

Drug therapy could substitute one abused drug for another.

The nurse working in the emergency department admits a client who arrived by ambulance and has respirations of 8 to 12 breaths per minute. The EMTs report finding an empty pill container of diazepam next to the client. The nurse anticipates administering what drug to this client?

Flumazenil Flumazenil is the antidote for benzodiazepine overdose.

The nurse who is working in the emergency department admits a 14-year-old who is exhibiting blurred vision, confusion, impaired breathing, muscle twitches, irregular heartbeat, and excessive sweating. The client's friends says the client bought a lot of cough syrup and has been drinking it all day. The nurse understands that the client has overdosed on what over-the-counter medication?

dextromethorphan

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding:

drug use.

A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for:

hypertension. Methamphetamine is a CNS stimulant that initially increases heart rate and blood pressure. This drug usually decreases appetite, energizes muscles, and causes some degree of mental and physical alertness.

A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of

marijuana.

The nurse is providing care for a client physically dependent on an opioid. How is physical dependence best characterized?

physiologic adaptation that results in unpleasant symptoms when the drug is stopped

While speaking to a group of elementary-aged children, the nurse is asked what sniffing gas or glue does to the body. What response is most effective in addressing this question?

"Doing that damages the brain and other body organs."

The high school nurse is explaining the dangers of substance abuse to the incoming freshman class. How would the nurse explain psychological dependence to the students?

"It involves feelings of satisfaction and pleasure from taking the drug."

The nurse is talking with a patient who is in the hospital from complications related to alcoholism. The patient states, "My father and grandfather were alcoholics. Do you think this is why I am?" What is the best response by the nurse?

"Many studies say that certain genes can cause alcoholism."

Which nursing interventions would the nurse implement to evaluate the therapeutic effects of chlordiazepoxide therapy? Select all that apply.

Assess vital signs. Monitor for restlessness and agitation. Monitor the client for examples of disturbed thought processes.

Which of the following instructions should a nurse provide a client with alcohol dependence who is prescribed disulfiram?

Avoid mixing disulfiram and alcohol

A client is agitated due to withdrawing from alcohol. Which group of drugs would assist the client?

Benzodiazepines

As a school nurse, you are preparing to do a presentation on cannabis and the long-term sequelae of its heavy use. To what body system or function do you understand cannabis use can cause the most damage?

Brain Cannabis use causes the greatest damage to the brain. This is because cannabinoid receptors are concentrated most heavily in the cerebellum, the part of the brain that controls motor coordination, and in the hippocampus, which governs learning and memory.

Nurses can help prevent drug abuse by all of the following EXCEPT:

Demanding drug testing for all clients. Because substance abuse often starts during childhood and adolescence, health professionals, parents, teachers, and others need to teach children about risks of drug abuse and strategies to resist peer pressure to use drugs of abuse; limit access to drugs of abuse; and support programs and activities designed to decrease drug abuse in this population. Nurses can help prevent drug abuse by administering drugs appropriately, using nondrug measures when possible, teaching clients about drugs prescribed for them, and participating in drug education programs.

A client admitted with substance abuse asks you to tell her when she will be released. She has not yet been evaluated by the medical team. Your best response would be:

In general, treatment depends on the type, extent, and duration of drug-taking behavior and the particular situation for which treatment is needed.

You are the nurse caring for a patient with a history of substance abuse. What would be an appropriate initial goal for this patient?

Longer periods of abstinence and sobrietyRecovery is life-long and requires total abstinence from the abused substance. The recovering person can never return to controlled use without rekindling the addiction. Hence, a realistic goal of treatment would be to achieve longer and longer periods of abstinence and sobriety. This goal needs to be emphasized during ongoing assessment and evaluation. Relapse prevention includes teaching patients to identify and manage feelings, recognize high-risk situations, and develop effective coping strategies.

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?

chlordiazepoxide Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants.

Which of the following medication is a narcotic antagonist?

Naloxone (Narcan)

A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?

Nausea The effectiveness of Antabuse relies on a drug interaction between ethanol and disulfiram to produce unpleasant and undesirable symptoms as a deterrent to alcohol ingestion. Symptoms include facial flushing, throbbing headache, hyperventilation, tachycardia, palpitations, nausea and copious vomiting, hypotension, shortness of breath, vertigo, syncope, confusion, and profuse diaphoresis.

A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior?

Psychological dependence The client is describing psychological dependence which involve feelings of satisfaction and pleasure from taking a drug. These feelings of dependence return the client to drug-taking behavior after periods of abstinence. Physical dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating a person continues to use a substance of abuse despite significant substance-related problems.

During his assessment, Drew reveals that he is a frequent user of crack and has been on a binge for several days. The nurse realizes that he requires frequent cardiac assessments. The reason for this increased assessment of the cardiac system is because of the major risk for what condition as a result of crack cocaine use?

Rupture of the aorta While nasal mucosal atrophy, hepatotoxicity, and renal ischemia are common adverse effects of cocaine, a person using crack faces an additional, usually fatal risk of sudden death due to acute myocardial infarction or rupture of the aorta. Cocaine sensitizes cardiac cells and causes an increase in contractility. Corresponding high levels of epinephrine secondary to excitement from cocaine cause the individual to be particularly susceptible to cardiac arrest.

Which of the following is a clinical manifestation of alcohol withdrawal?

Seizures A clinical manifestation of alcohol withdrawal include seizures. Tachycardia, hypertension, and diaphoresis are additional clinical manifestations.

When questioned about her alcohol usage, a female client states that she drinks three martinis a night. What assessment should the nurse make of this statement?

She may have understated the amount of alcohol consumed. Abusers of alcohol and other drugs are not reliable sources of information about the types or amounts of drugs used. Most abusers understate the amount and frequency of substance use

A family expresses concern when a family member withdrawing from alcohol is given lorazepam (Ativan). What information should be given to the family about the medication?

The medication is given for a short time to help the client complete the withdrawal process

The nurse is taking a history from a patient who states that she smokes marijuana daily. The patient says, "It mellows me out and helps me to cope with the stresses of life. I go sometimes without it and it doesn't bother me." What does the nurse determine is this patient's issue with the substance?

The patient has developed a psychological dependence for marijuana.

The patient tells the nurse, "I have been having to take more and more of my pain medication to alleviate this pain in my back. It is not working as well as it was." What does the nurse understand is occurring with the medication?

The patient has developed a tolerance to the medication and requires more medication to get the same effect.

A client diagnosed with a substance use disorder asks why it is necessary to attend counseling in addition to the medication being prescribed. What statement should inform the nurse's response?

There is no plan for the treatment of drug addiction that is completely effective. Overall, treatment regimens that combine counseling and behavioral therapy with drug therapy are more successful than those using drug therapy alone. This does not mean, however, that psychological disorders always underlie addiction.

What happens when clients return to opiate abuse while taking naltrexone?

They do not experience the previous level of opiate effects Naltrexone is used for opiate addiction. When clients return to opiate abuse while taking naltrexone, they do not experience the previous level of opiate effects. They do not have increased potential for overdose and death. In addition, they do not experience any physiologic consequences of withdrawal and are not depressed and prone to commit suicide.

The nurse is caring for a client for whom a psychological therapy has been ordered to assist with recovery from an addictive disorder. The nurse understands that what statement is true about psychological rehabilitation efforts?

They should be part of any treatment program for a drug-dependent person.

Charlie, a homeless heroin addict, has been admitted into care and needs immediate intervention. A visiting health care provider has begun Charlie on methadone maintenance. What fact should the nurse consider during this client's treatment for substance use?

Using methadone maintenance may lead to a dependence on methadone.

A client admits to smoking marijuana several times a day but denies being dependent on the drug. The nurse should base the discussion with the client on what characteristic of psychological dependence?

Using the drug creates the feeling of satisfaction and pleasure. Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug abuse patterns, and return to drug-taking behavior after periods of abstinence.

When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for?

sedation The side effects of benzodiazepines are sedation, confusion, restlessness, bradycardia, tachycardia, urinary retention or incontinence, and drug dependence. The nurse should observe the client for excessive sedation and should use benzodiazepines cautiously in clients with impaired kidney or liver function.