Substance Abuse
A patient receives a prescription for nicotine lozenges. What education should the nurse provide?
"Avoid eating soft foods." "Use the medication for four weeks." "Take one lozenge every six hours." "Avoid taking this medication with food." Nicotine lozenges can increase gastrointestinal side effects when ingested with food and drink. Therefore the nurse should tell the patient to not take the medication with food. Because nicotine lozenges cause mouth soreness, the patient should be told to eat soft and non-spicy foods. The nurse should not instruct the patient to use the medication for four weeks; nicotine lozenge use is recommended for 8 to 12 weeks. At the start of therapy, a lozenge should be taken every one to two hours and then every four to eight hours by the 12th week. p. 150
The nurse is talking to a patient who is being treated for an acute exacerbation of chronic obstructive pulmonary disease. The patient states that he or she is not interested in quitting smoking at this time. Which of these statements by the nurse is appropriate at this time?
"If you continue to smoke, your breathing problems will get worse. Let me describe how that will happen." The Agency for Healthcare Research and Quality (AHRQ) has issued the Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update to aggressively motivate smokers and other tobacco users to quit. Five brief clinical interventions should be used at each encounter with a patient. These interventions are designed to identify tobacco users, encourage them to quit, determine their willingness to quit, assist them in quitting, and arrange for follow-up to prevent relapse. The nurse should not tell the patient that some smokers never quit. The nurse should not tell the patient that she will not say anything to the patient unless he or she is ready to quit. p. 147
Which response is appropriate when teaching a client regarding a prescription for naltrexone?
"It helps prevent relapse by reducing your drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. Improving mood, preventing flashbacks, and helping one to sleep do not accurately describe the action of naltrexone.
A client with a history of chronic alcohol use is prescribed disulfiram to treat the addiction. Which information concerning the effect of this medication should the nurse provide the client?
"You can experience adverse effects if you consume alcohol while taking this medication." Disulfiram is used to treat substance abuse in clients. The client should be sure to avoid consuming alcohol during the course of medication. The drug reacts with alcohol to form a toxic reaction, resulting in gastrointestinal and respiratory disorders. Nausea, seizures, and sedation are not observed in the course of this medication. Nausea is observed when a client consumes alcohol during the course of drug therapy. Seizures and sedation are observed during the course of medications like chlordiazepoxide (Librium), phenobarbital (Phenobarbital), and diazepam (Valium).
What symptoms are most suggestive of marijuana use by a client?
A client who has been using marijuana may have an increased appetite and anxiety. People who use marijuana frequently get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from γ-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD).
A client diagnosed with mouth cancer should be assessed for which type of substance abuse?
Addiction to tobacco causes disorders that include chronic lung disorders and mouth cancer. These symptoms are not seen in cases of opium, alcohol, and cocaine addictions. Addiction to opium may result in constipation, hepatitis, and endocarditis. Addiction to alcohol may result in loss of consciousness, visual distortions, sexual dysfunction, and liver and heart disorders. Addiction to cocaine may result in hypertension.
The nurse is providing care for a patient who has been admitted with alcohol withdrawal delirium. Which intervention should be the first priority for the nurse?
Administering benzodiazepines Benzodiazepines frequently are used to treat the signs and symptoms of alcohol withdrawal delirium and should be administered as soon as possible. Physical restraints are rarely necessary if drugs administered during withdrawal are used appropriately. Knowledge about the patient's last alcohol intake is not necessary because withdrawal symptoms are occurring already. Information about treatment for alcohol dependency is not appropriate at this acute stage.
The administration of a member of what medication classification is the nurse's priority intervention when caring for a client experiencing severe alcohol withdrawal symptoms?
Anticonvulsants The client experiencing severe symptoms of alcohol withdrawal may experience generalized seizures, which are managed by administration of prescribed anticonvulsant medication. This treatment is the most important nursing intervention in clients with severe alcohol withdrawal symptoms. Prescribed hypnotic medications are administered to treat insomnia, which is a mild symptom of alcohol withdrawal. Anorexia is also a mild symptom of alcohol withdrawal and can be managed with suitable appetite stimulants. Clients with severe alcohol withdrawal symptoms may experience a high-grade fever. The nurse should administer the prescribed antipyretic to reduce the fever; however, it is not the most important intervention.
A nurse is assessing a patient who has been admitted to the hospital after an epileptic episode. The patient has been consuming alcohol for the past 15 years. The patient suddenly stopped consuming alcohol two days ago. The nurse expects the patient to report what symptoms associated with alcohol withdrawal? Select all that apply.
Anxiety Apathy Agitation Prolonged sleep Auditory disturbances The seizures this patient experienced may have been caused by alcohol withdrawal. Seizures are a major withdrawal symptom and need immediate treatment. The patient is likely to have other symptoms of alcohol withdrawal such as agitation, anxiety, and auditory disturbances. Apathy and prolonged sleep are manifestations of cocaine withdrawal. p. 151
While conducting research studies on the effects of cigarette smoking, a nurse identifies that which conditions can be caused by cigarette smoking? Select all that apply.
Anxiety Cataracts Insomnia Periodontitis Chronic obstructive pulmonary disease Among the various health conditions caused by cigarette smoking are cataracts, periodontitis, and chronic obstructive pulmonary disease. Anxiety and insomnia are not caused by tobacco consumption. p. 147
Electronic cigarettes are battery-operated devices that turn nicotine and other chemicals, including propylene glycol and flavorings, into an aerosol. A patient is trying to quit smoking and asks the nurse about e-cigarettes. What information can the nurse provide? Select all that apply.
Any harmful effects of e-cigarettes are still not fully known. Carcinogens have been found in some e-cigarette cartridges. E-cigarettes are good substitutes for cigarettes and help with smoking cessation. Pulmonary irritants and some endotoxins have been found in some e-cigarette cartridges. E-cigarettes decrease the risk of smoking-related cardiovascular and pulmonary disorders. Carcinogens, pulmonary irritants, and endotoxins have been found in some e-cigarettes. Not enough research has been done on e-cigarettes to assume they are safe alternatives to smoking. E-cigarettes are not good substitutes for cigarette smoking and do not help with smoking cessation, as they contain nicotine. E-cigarettes increase the risk of cardiovascular and pulmonary disorders, since they contain nicotine resulting in vasoconstriction. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 146
A patient with a history of alcohol abuse vomits blood and experiences black, tarry stools. The nurse suspects that the cause of the problem is the patient's consumption of alcohol while taking what medication?
Aspirin Aspirin is a nonsteroidal antiinflammatory drug (NSAID) that acts by blocking the action of cyclooxygenase-1; aspirin enhances the risk of gastrointestinal bleeding and ulcers when consumed with alcohol. Because black, tarry stools are associated with gastrointestinal bleeding, the nurse can conclude that the patient might consume alcohol with aspirin. A mix of alcohol and varenicline does not lead to gastrointestinal bleeding. Consuming alcohol with acetaminophen increases the risk of liver damage. Consumption of alcohol along with chlordiazepoxide can lead to acute alcohol toxicity, resulting in respiratory and cardiac failure. Test-Taking Tip: Gastrointestinal bleeding is caused when alcohol is consumed with an NSAID. Identify the NSAID. p. 149
Which assessment data would be most consistent with a severe opiate overdose
Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min The data consistent with opiate overdose are blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min. Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression
A patient who is prescribed a non-nicotine agent for tobacco withdrawal is demonstrating aggressive behavior and depression. Which medication does the nurse suspect is causing the behavioral changes?
Bupropion Bupropion is a non-nicotine agent that aids smoking cessation. This medication can cause severe neuropsychiatric symptoms such as changes in behavior, hostility, agitation, depressed mood, suicidal thoughts, and behavior, and attempt to commit suicide. Carbamazepine is not used to aid smoking cessation. Chlorpromazine is an antipsychotic agent that does not help smoking cessation. Chlordiazepoxide is a benzodiazepine prescribed to patients suffering from alcohol withdrawal; it does not produce behavioral changes.
Which antidepressant medication approved by the Food and Drug Administration (FDA) is a smoking cessation aide that can help a patient adhere to a plan to quit smoking?
Bupropion Bupropion is an antidepressant medication approved by the FDA as a smoking cessation aide. Bupropion is known to reduce the urge to smoke and decrease some symptoms of withdrawal, and it helps prevent weight gain associated with smoking cessation. Lithium is a mood-stabilizing agent used to manage manic and depressive episodes in bipolar disorder. Olanzapine is an atypical antipsychotic medication. Digitalis is a cardiac glycoside used to manage some cardiac disorders.
The nurse recognizes that patients who use nicotine are at risk for what conditions? Select all that apply.
Cataracts Chronic sinusitis Glomerulonephritis Respiratory depression Abdominal aortic aneurysm Smoking, the most harmful method of nicotine use, can cause cataracts and abdominal aortic aneurysm. Ingestion of cocaine can lead to stroke, chronic sinusitis, psychosis, and cardiac dysrhythmias. Opioid use can cause glomerulonephritis. Using sedative hypnotics can cause respiratory depression and possible memory impairment. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 147
Upon examination, the nurse finds that the client who has acknowledged abusing drugs is experiencing nasal damage. Which substance does the nurse suspect is being abused?
Cocaine is a stimulant and is administered by smoking, injecting, or snorting. Snorting cocaine causes nasal damage. Lysergic acid diethylamide (LSD) is a hallucinogen, which is swallowed or absorbed through tissues in the mouth. Opium is an opioid, which is swallowed or smoked. Hashish is a cannabinoid, which is smoked or swallowed.
A client hospitalized 3 days ago with vomiting and tachycardia, is now both irritable, restless and diaphoric. What is the nurse's best action?
Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Vomiting and tachycardia are medical complications of withdrawal from chronic alcohol abuse; the admitting diagnosis is a clue to be observant for alcohol-related problems. Diaphoresis (sweating) and fever are associated with alcohol withdrawal. Irritability and restlessness are additional clues to alcohol withdrawal. These symptoms are not associated with opioid abuse. Reactions to blood transfusions occur immediately. The client's sweating is likely a result of alcohol withdrawal and not excessively high room temperature.
A client with a history of cocaine abuse is brought to the hospital in an unconscious state. Which nursing intervention will the nurse implement?
Observation for cardiac dysfunction The nurse should observe the client for cardiac dysfunction, which may be observed in clients experiencing central nervous system stimulant overdose. The nurse should not induce vomiting while the client is unconscious. Ammonium chloride is a treatment for amphetamine overdose. Cocaine is not an opiate, so opiate withdrawal symptoms are not relevant to this client.
The nurse should inform a patient to expect what change two days after smoking cessation?
Decreased cough Decreased respiratory rate Increased sensation of taste Increase in body temperature at the extremities
Which finding does the nurse expect in a patient who smoked a cigarette 20 minutes prior to the nurse's assessment?
Decreased pulse rate Increased lung function Increased blood pressure Decreased respiratory rate A decrease in blood pressure and pulse rate in addition to an increase in the body temperature at extremities are observed 20 minutes after smoking a cigarette. Increased lung function and decreased respiratory rate are observed in a patient two weeks to three months after smoking cessation. Increased blood pressure is seen in a patient who smokes for a long duration. p. 149
The nurse suspects that a patient is experiencing alcohol-withdrawal delirium based on what assessment findings?
Disorientation Visual hallucinations Increased hyperactivity without seizures Alcohol-withdrawal delirium is characterized by disorientation, visual or auditory hallucinations, and increased hyperactivity without seizures. Nystagmus is a symptom of Wernicke encephalopathy. Decreased blood pressure is a withdrawal symptom of tobacco. p. 151
The nurse is educating a group of adolescents about different kinds of substance abuse. In which category can magic mushrooms be classified?
Hallucinogens Substances may be classified according to their mechanism of action. Magic mushrooms, a common street name of psilocybin, can be classified as hallucinogens for their severe hallucinogenic effects. Stimulants, cannabinoids, and opioids are other categories of substances. Cocaine, amphetamine, and methamphetamine are stimulants. Marijuana and hashish are cannabinoids. Heroin and opium are opioids.
The nurse should monitor a patient who uses nicotine gum for what side effects?
Hiccups and mouth ulcers are common side effects caused by the use of nicotine gum. Rhinitis is a side effect of nicotine nasal spray. Heartburn occurs with the use of a nicotine inhaler. Constipation is associated with the use of varenicline. p. 150
The nurse suspects that a patient is experiencing major alcohol withdrawal syndrome based on what clinical manifestations?
Hypertension Gross tremors Increased heart rate Hypertension, gross tremors, and increased heart rate are clinical manifestations of alcohol withdrawal syndrome. Disorientation and visual hallucinations are associated with alcohol withdrawal delirium. p. 151
Cocaine exerts which of the following effects on a client?
Increased metabolism Cocaine exerts a stimulant effect on metabolism and may cause extreme weight loss. Cocaine does not cause drowsiness. Imbalanced emotions and paranoia may occur during cocaine withdrawal.
The nurse should inform a patient to expect what change two days after smoking cessation?
Increased sensation of tasteSmoking reduces the functioning of taste buds on the tongue, increases coughing, increases shortness of breath, and decreases body temperature. Two days after smoking cessation, smell and taste sensations improve. A decrease in coughing and respiratory rate is observed two weeks to three months after smoking cessation. An increased body temperature at the extremities is observed 20 minutes after smoking cessation. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 149
When caring for a patient with acute intoxication and a history of chronic alcoholism, the nurse will anticipate administrating which drug?
Intravenous (IV) thiamine and glucose Wernicke encephalopathy, a complication of chronic alcohol abuse, potentially is preventable and reversible with the administration of intravenous (IV) thiamine. Patients with alcohol intoxication also may experience hypoglycemia, decreased serum magnesium, and other signs of malnutrition. For this reason, they may be treated with IV glucose, magnesium sulfate, and multivitamins. The administration of an opioid analgesic (morphine sulfate) is not indicated. Flumazenil is the reversal agent for benzodiazepines, and naloxone is the reversal agent for opioids.
While assessing a patient with a history of chronic alcohol use, the nurse finds involuntary eye movements, poor balance, and uncoordinated walking. Which medication should the nurse expect to be prescribed for the patient?
Involuntary eye movements, poor balance, and uncoordinated walking are signs of Wernicke encephalopathy, a condition that arises from chronic alcoholism. The alcohol-induced suppression of thiamine absorption is mainly responsible for this condition; thus thiamine should be prescribed. Varenicline is used for smoking cessation. Chlorpromazine is an antipsychotic medication used to treat seizures associated with alcohol withdrawal. Chlordiazepoxide is a benzodiazepine used to reduce anxiety and prevent seizures and delirium associated with alcohol withdrawal. p. 149
The nurse is teaching a patient about varenicline prescribed to aid in smoking cessation. When discussing the patient's adherence to this plan, what is an important teaching point to include?
It is safe to have wine with dinner while you are taking varenicline. Some people have seizures during the first month of therapy. If this occurs, keep taking varenicline as seizure activity will subside over time. If you have a change in behavior such as agitation, depression, or suicidal thoughts, stop taking varenicline and call your primary health care provider right away. Some people experience blisters and swelling in their mouth and throat. Continue to take varenicline as these side effects will subside over a few days. Varenicline has been prescribed as an aid to smoking cessation, but there are dangerous side effects the patient must be taught to recognize and report. Some patients experience behavioral changes such as agitation, depression, or suicidal thoughts. The patient should be advised to stop the medication and call the primary health care provider right away. All alcoholic beverages such as wine should be avoided while taking varenicline. Varenicline should be stopped and the primary health care provider notified if the patient develops seizures or blisters in the oral cavity. pp. 147-148
The nurse is assessing an alcoholic patient who has an irreversible form of amnesia characterized by short-term memory loss. Which associated condition does the nurse suspect in the patient?
Korsakoff's psychosis Korsakoff's psychosis is a neurologic disorder caused by a lack of thiamine in the brain. Its onset is linked to chronic alcohol abuse and leads to a severe form of amnesia. Korsakoff's psychosis is the continuum of Wernicke encephalopathy, which is less severe and caused by lack of thiamine due to alcohol abuse. Coronary artery disease and chronic obstructive pulmonary disease (COPD) are seen in patients addicted to nicotine and smoking. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. pp. 149, 151
The nurse recalls that which medication helps prevent seizures and delirium in a patient that is experiencing alcohol withdrawal?
Lorazepam Lorazepam is a benzodiazepine used to reduce and prevent seizures and delirium caused by alcohol withdrawal. Thiamine is used to prevent Wernicke encephalopathy. Bupropion and clonidine are used to help patients quit smoking.
The nurse recognizes that which medication is used to treat alcohol-withdrawal delirium?
Lorazepam Lorazepam is a benzodiazepine used to treat alcohol-withdrawal delirium. Bretylium is an antiarrhythmic agent used to treat ventricular dysrhythmia caused by cocaine or amphetamine toxicity. Methadone is an opioid medication that reduces the withdrawal symptoms of heroin. Nortriptyline is a tricyclic antidepressant used to aid smoking cessation. page 151
The nurse assessing a client with a history of substance abuse discovers significant dental problems. This finding is associated with the abuse of which substance?
Methamphetamines Abuse of methamphetamine is associated with severe dental problems, such as cracked teeth. Perception disorders may occur with hallucinogen use. Alcohol abuse is associated with gastrointestinal erosion as well as other physiological consequences. Abuse of inhalants is damaging to the respiratory tract.
A nurse is providing teaching to a patient with oral ulcers due to the use of nicotine gum. The nurse should include what side effects of nicotine replacing agents in the education?
Nausea Hiccups Cough The side effects of nicotine-replacing agents include nausea, hiccups, and cough. Nicotine replacement therapy does not cause diarrhea or angina. p. 150
A nurse is caring for a patient injured in a car crash. The patient is manifesting signs of alcohol withdrawal delirium. Which does the nurse identify as signs of alcohol withdrawal delirium?
Nausea Seizures Sweating Gross tremors Visual hallucinations Visual or auditory hallucinations, gross tremors, and seizures are signs of alcohol withdrawal delirium. Sweating and nausea are some of the signs of alcohol withdrawal syndrome. These symptoms may also be present during alcohol withdrawal delirium, but these symptoms alone would not be enough to identify the condition. p. 151
The nurse is caring for a patient admitted to the health care facility with acute alcohol toxicity. Which would the nurse identify as a sign of Wernicke encephalopathy?
Nystagmus Eye abnormalities such as nystagmus, or paralysis of the lateral rectus muscles, indicate Wernicke encephalopathy. Hypoglycemia is not indicative of Wernicke encephalopathy; however, administration of glucose-containing IV solutions to the patient may precipitate Wernicke encephalopathy in a previously unaffected patient. Most patients with Wernicke encephalopathy have decreased serum magnesium levels and other signs of malnutrition. Potential for violence is not related to Wernicke encephalopathy. p. 151
A nurse is assessing a patient who is a chronic alcoholic. On observing the patient's eyes, the nurse suspects that the patient may be suffering from Wernicke encephalopathy. Which abnormality of the eye might have led the nurse to this suspicion?
Nystagmus Nystagmus is an abnormality of the eye commonly seen in patients suffering from Wernicke encephalopathy. Decreased visual acuity can have various causes, such as aging, cataract, infections, and increased intraocular pressure. Pupils may dilate in response to light or medications. Strabismus is an eye disorder characterized by the inability to focus both eyes on one object.
The nurse is caring for a patient who has received counseling for smoking cessation. Which observation indicates that the patient has not smoked cigarettes for 12 hours?
Oxygen level 96% Smoking can reduce oxygen levels and increases carbon monoxide levels in the blood. The normal level of oxygen in the blood is between 95% and 100%. Twelve hours after smoking cessation, the carbon monoxide level in the blood decreases to normal and the oxygen level in the blood increases to normal. Body temperature at the extremities is increased after 20 minutes of smoking cessation. The normal respiratory rate is 12 to 16 breaths/minute; the normal rate will occur two weeks to three months after smoking cessation. Smoking does not discolor the skin. p. 149
An adult client is currently experiencing amphetamine withdrawal. Which assessment finding is a common characteristic of this process?
Psychomotor retardation Withdrawal from amphetamines is commonly associated with symptoms of depression. Psychomotor retardation commonly accompanies depression. Dilated pupils, dry oronasal cavity, irregular heart rate, and excessive motor activity are symptoms of amphetamine intoxication.
The nurse should monitor a patient who uses a nicotine inhaler for what side effects? Select all that apply.
Rhinitis Nausea Heartburn Mouth ulcers Throat irritation A nicotine inhaler is used for smoking cessation. Side effects include nausea, heartburn, and throat irritation. Rhinitis is a side effect associated with the use of nicotine nasal spray. Mouth ulcers are a possible side effect of nicotine gum usage. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. p. 150
A patient has been trying to quit chewing tobacco. The nurse recognizes that the patient might experience which symptoms? Select all that apply.
Seizures Headache Restlessness Pain in the abdomen Drowsiness or insomnia When a patient is trying to withdraw from chewing tobacco, the patient may experience various withdrawal symptoms such as headache, restlessness, drowsiness, and insomnia. These withdrawal symptoms occur due to the reduced levels of nicotine. Stopping tobacco use does not cause pain in the abdomen or seizures. Nicotine replacement therapy can be administered to these patients to help them quit nicotine use safely. p. 146
Which type of commonly abused drug causes increased mental alertness?
Stimulants Stimulants act on the central nervous system to increase energy, heart rate, and mental alertness. Alcohol can cause mild stimulation and relaxation; in higher doses it causes impaired memory. Opioids cause impaired coordination, confusion, and drowsiness. Cannabinoids cause relaxation, disturbed balance and coordination, and impaired memory and learning.
A nurse is caring for a patient who is experiencing alcohol withdrawal syndrome. Which symptoms are considered symptoms of this syndrome? Select all that apply.
Sweating Nausea Insomnia Seizures Hallucinations Alcohol withdrawal syndrome occurs when a person who is dependent on alcohol stops drinking alcohol abruptly. It may occur 4 to 6 hours after the last drink. The symptoms of alcohol withdrawal may last up to 14 days. The symptoms include sweating, nausea, and insomnia. Seizures and hallucinations are symptoms of alcohol withdrawal delirium and require immediate intervention. p. 151
A patient with a history of chronic alcohol use is hospitalized. The nurse should monitor the patient for what withdrawal symptoms?
Tachycardia Hypotension Hyperreflexia Gross tremors Hyperirritability Tachycardia (increased heart rate), hyperreflexia (over-responsive reflexes), and gross tremors are withdrawal symptoms of alcohol. Hyperirritability and hypotension are withdrawal symptoms of smoking. p. 151
A patient admitted to the hospital early in the morning for elective surgery asks the nurse to go outdoors to have one last cigarette before surgery. What is the nurse's most appropriate response to the patient's request?
Tell the patient that smoking is not allowed anywhere on hospital property. Notify the health care provider that the patient may need an over-the-counter nicotine replacement agent. Contact the anesthesia care provider to ensure that the patient's smoking history is noted as a risk factor for surgery. Inform the patient that this would be an ideal time to quit smoking because he or she won't want to smoke right after surgery.
A client was in an automobile accident, and although there is the odor of alcohol on the client's breath, the client's speech is clear, and the client is alert and can answer questions. The client's blood alcohol level is determined to be 0.30 mg %. What conclusion can be drawn?
The client has a high tolerance to alcohol. The client has a high tolerance to alcohol. A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. This scenario is not suggestive of the client eating a high-fat meal or having decreased tolerance to alcohol. The blood alcohol level is well above the legal limit in most states.
A nurse is caring for a patient who has acute alcohol intoxication. On taking the history from the caregivers, the nurse finds out that the patient had completely stopped consuming alcohol for two years and started again a week ago. How should the nurse interpret this behavior?
The patient has relapse of alcohol dependence. Returning to substance abuse after a period of abstinence is called relapse. The term "dependence" means that a person relies on a substance to such an extent that its absence causes impairment in body functions. Abstinence is the avoidance of substance use. Addiction is the term used to describe the compulsive, uncontrollable dependence on a substance. p. 145
A nurse is assessing a couple who are chronic alcoholics. The couple reports that they both consume the same amount of alcohol every day. However, on checking the blood alcohol concentration reports, the wife is found to have a greater blood alcohol concentration than the husband. What could be the most likely reason for this finding?
The rate of metabolism of alcohol in the stomach is lower in females than in males. Stomach metabolism in females is much less than that of males. Therefore if both the husband and the wife consume the same amount of alcohol, it is possible that the blood alcohol concentration in the wife would be greater than that of the husband because of the lower rate of alcohol metabolism. Alcohol dependence, a mistake in the blood alcohol assessment, and contamination of blood samples are less likely reasons for such a finding. p. 148
What is the most likely nursing assessment finding when providing care for an alcohol-dependent client experiencing uncomplicated moderate alcohol withdrawal?
Tremors Tremors are a sign of mild to moderate alcohol withdrawal. Seizures may be associated with alcohol overdose or withdrawal from heavy use. Blackouts may occur during substance use events. Hallucinations may occur from moderate to severe alcohol withdrawal.
The nurse is caring for a patient who has decided to quit smoking. What should the patient education include?
Use a nicotine-replacement agent. Try to lower stress levels by snacking. Rid the environment of tobacco products. Call an ex-smoker when the urge to smoke occurs. Limit weight gain with a calorie-reduction eating plan. Use of a nicotine-replacement agent helps by reducing cravings and withdrawal symptoms by supplying the body with smaller amounts of nicotine. Removing tobacco products from the environment, including the smell of tobacco, helps to avoid a relapse. Calling an ex-smoker if the patient feels the urge to smoke is a proven method for helping to talk the patient out of smoking. Stress levels should be managed with exercise and alternative modalities. Snacking when stressed may lead to weight gain and promote unhealthy eating habits. Limiting weight gain by dieting is not a recommended behavior while quitting smoking. The focus should be on changing one behavior at a time. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 149
The nurse recognizes that a patient with a history of chronic alcohol abuse is at risk for which complication?
Wernicke encephalopathy is a degenerative condition of the brain that occurs due to thiamine deficiency and alcohol-induced suppression of thiamine absorption. Lung cancer, prostate cancer, and esophageal cancer may occur due to nicotine abuse.
A nurse is creating a dietary plan for a patient who is a chronic alcoholic who has been diagnosed with Wernicke encephalopathy. Why should the nurse include food items rich in vitamin B 1 in the patient's diet plan?
Wernicke encephalopathy is caused by a deficiency of thiamine. Wernicke encephalopathy is caused by a deficiency of vitamin B 1 (thiamine). Alcohol inhibits thiamine absorption from the gut; therefore, this condition is commonly seen in chronic alcoholics. The nurse should ensure that the patient quits consuming alcohol and consumes an adequate amount of vitamin B 1 to prevent Wernicke encephalopathy. Vitamin B 1 does not help manage alcohol withdrawal symptoms or addiction. Thiamine does not counteract side effects of medications used to treat Wernicke encephalopathy. page 149
The nurse assesses a patient's tobacco use status. The patient does not smoke tobacco but is addicted to the use of snuff. Which should the nurse teach the patient is the most likely complication arising from the use of snuff?
gingiva Pneumonia Cancer of the mouth Cardiovascular disease Addiction to tobacco in the form of snuff may lead to systemic effects on the cardiovascular system, thus increasing the risk for cardiovascular disease. Chewing on tobacco leaf is the form of tobacco addiction that is more likely to cause cancer of the mouth and gingiva. Smoking is the most harmful method of nicotine use; one of the many complications includes pneumonia. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process. p. 146
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what drug?
γ-hydroxybutyrate (GHB) The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies") and GHB and its congeners. These drugs are odorless, tasteless, and colorless, mix easily with drinks, and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. Cathinone is an amphetamine-like stimulant. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Clonidine is a centrally acting alpha-agonist hypotensive agent.