Substance-Related & Addiction Disorders | Engage Mental Health RN

Day 1 Admission note: 55-year-old client admitted with long-standing history of alcohol use disorder. Recently involved in motor vehicle accident and now seeking inpatient detoxification and tx for alcohol use disorder. BAL at time of accident was 0.33 mg/dL. Reports drinking "hard liquor" since age 14. Also states, "I drink about 10- 12 drinks of vodka a day." 0800: Client reports drinking "several shots of vodka yesterday". Tremulousness of hands noted. Client refuses food currently, stating, "I'm nauseated." 1600: Assisted client to complete Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-Ar) document. Client's score is 32. ____________ Complete the following sentence by using the lists of options: "Client is at highest risk for developing ___1_____ as evidenced by the client's _____2_____." 1: moderate withdrawal, severe withdrawal, mild withdrawal 2. nausea, CIWA-Ar score, tremulousness

"The client is at highest risk for developing severe withdrawal as evidenced by the client's CIWA-Ar score." *Clients scoring higher than 19 can experience delirium and hallucinations and should receive a prescription for a medication to reduce the risks to the client.

Day 1: 19-year-old client admitted for evaluation of potential substance use disorder. Client lives w/ adult parents & is enrolled in college courses leading to an associate degree in accounting. Client regularly attends spiritual services w/ their father. Client acknowledges that they've been dating same individual for 18 months, & "we plan to move into together" Day 2: Client revealed during group therapy that they were physically abused by a family member while they were adolescent. Stated" Mom is depressed and has been taking pills for long time." Client acknowledged that their fav. uncle has been "smoking dope & taking pain pills for as long as I can remember." ________ Select 2 findings that require immediate follow up: - Statement regarding client's uncle - Living arrangements - Spiritual affiliations - Revelation of what occurred while client was an adolescent - Educational status - Relationship status

- statement regarding clients uncle - revelation of what occurred while client was an adolescent

A nurse is meeting w/ a new client at a substance use disorder clinic. During the meeting, the nurse learns from the client that they were treated for both asthma & anxiety as a child. The nurse is collecting which of the following types of data from the clients account? A) historical B) secondary C) subjective D) objective

A) historical

A nurse is meeting w/ a new client at a substance use disorder clinic. The nurse & the client are discussing the clients care plan, including medication, follow up appointment scheduling, & referral to support groups. The nurse is completing which of the following phases of the nursing process? A) planning B) implementation C) evaluation D) analysis/diagnosis

A) planning

A nurse should identify that which of the following factors is a protective factor that prevents younger people from developing addictions? A) positive relationships B) married parents C) living in the midwest portion of the US D) participating in team sports

A) positive relationships

A nurse is providing education to a group of clients about addiction. The nurse should include which of the following as a definition of addiction? A) recurring uncontrollable urges to engage in compulsive behaviors such as substance use in spite of negative consequences B) needing more & more of a substance to get the level of high or enjoyment as earlier use C) physiological manifestations that happen when drug or alcohol use is stopped D) wanting to cut down or stop using drugs and/or alcohol but not being able to

A) recurring uncontrollable urges to engage in compulsive behaviors such as substance use in spite of negative consequences

A nurse has successfully completed a drug treatment program & is returning to work 3 months later w/ restrictions on their nursing license. Which of the following restrictions might the nurse have for practicing nursing after treatment for drug addiction? A) the nurse can care for clients but cannot administer narcotics B) the nurse can do paperwork on the unit but not care for clients C) the nurse can work as a client care assistant but not an RN D) the nurse can care for clients but not administer any type of medications

A) the nurse can care for clients but cannot administer narcotics

Admission Note - Day 1: 41-year-old client admitted with substance use disorder. Client was injured several years ago and subsequently developed an addiction to pain medications. Client is an RN and has been employed at a local health care facility on a medical-surgical unit. Day 3: Expressing remorse regarding dependence on and misuse of prescription medications. Reports they have diverted narcotics while working but doesn't believe anyone knows about it. States, "I want to get better and take responsibility for my actions. Will I ever be able to work as a nurse again? ________________________________ For each potential disciplinary action, specify if the action is anticipated or unexpected for the client - State board of nursing will investigate. - Immediate loss of license. - Enrollment into a monitoring/recovery program. - Criminal charges and arrest.

Anticipated - State board of nursing will investigate. - Enrollment into a monitoring/recovery program. ______________ Unexpected - Immediate loss of license. - Criminal charges and arrest.

A nurse is developing a discharge plan for a client who is in substance use rehabilitation. The nurse should include which of the following treatment modalities to decrease the likelihood of relapse? A) physical therapy, occupational therapy, pet therapy B) 12 step program, cognitive behavioral therapy, support groups C) intensive long term residential treatment D) art therapy, music therapy, yoga

B) 12 step program, cognitive behavioral therapy, support groups

A nurse is caring for a client who is experiencing withdrawal from alcohol. The nurse should use which of the following assessment tools in their treatment of this client? A) AUDIT B) CIWA-Ar C) CAGE D) MAST

B) CIWA-Ar *used to determine severity of alcohol withdrawal and needed medication to manage the withdrawal safely.

Which of the following is a guiding principle for nurses when providing care to clients who have a substance use disorder? A) addiction is a choice; clients need to realize it is their fault B) addiction is a complex brain disorder; health care providers need to treat clients who have addictions w/ empathy & compassion C) the underlying etiology of addiction is unknown D) addiction is caused by the cognitive deficits in the brain; which results in the clients inability to change

B) addiction is a complex brain disorder; health care providers need to treat clients who have addictions w/ empathy & compassion

A nurse is caring for a client who is hospitalized for gallbladder removal surgery. On their first postoperative day, the client has agitation, a high temp, increased respirations, irritability, & confusion. The nurse should recognize that the client may be experiencing withdrawal from which of the following substances? A) hallucinogens B) alcohol C) heroin D) stimulants

B) alcohol

A nurse is providing education to a group of clients about neurotransmitters. Which of the following neurotransmitters should the nurse include that is implicated in the reward pathway of the brain & addiction? A) serotonin B) dopamine C) norepinephrine D) y-aminobutyric acid

B) dopamine

A nurse is meeting w/ an established client at a substance use disorder clinic. The client has been in treatment for 6 months. In this meeting, the client shares w/ the nurse that their partner previously would bail them out of jail when they were arrested for DUI. The client says that their partner would also call in to their workplace & tell the supervisor the client was too ill to come to work when they were hung over from drugs or alcohol. The partners behavior is indictive of which of the following? A) codependency B) enabling C) intervention D) passive aggressiveness

B) enabling

A nurse is caring for a client whose alcohol use is determined to be heavy. The nurse should identify that the client is at risk of developing which of the following conditions? A) bipolar disorder, schizophrenia, PTSD B) hepatitis, pancreatitis, cirrhosis of the liver C) parkinsons disease, tardive dyskinesia, brain swelling D) lupus & other autoimmune disorders

B) hepatitis, pancreatitis, cirrhosis of the liver

A nurse is caring for a client in a substance use disorder clinic. The client was referred by their health care provider, who is concerned that they might have a problem w/ misusing prescription pain medication. Although the client has kept this appointment, they insist there is nothing wrong w/ them & that they do not have a problem w/ their pain pills. Which statement by the client might indicate a substance use disorder? A) i have been prescribed pain medication for 3 years because of a back injury B) my provider is just mad that i have missed three appointments w/ them & haven't gotten my annual screening this year C) i try to get out & take walks when the pain lets up D) i am planning on moving in w/ my sister so she can help me

B) my provider is just mad that i have missed three appointments w/ them & haven't gotten my annual screening this year

Which of the following factors is identified as a risk factor for developing addictions? A) high school performance B) peer pressure C) higher socio-economic status D) independent nature

B) peer pressure

a nurse is caring for a client who was hospitalized w/ a high blood alcohol content level. The provider fears the client may go into withdrawal & require medical supervision. The clients manifestations now include anxiety, tremors, BP 166/100 mm Hg & tachypnea. The nurse should recognize that the client is experiencing which of the following stages of withdrawal from alcohol? A) stage 1 (mild) B) stage 2 (moderate) C) stage 0 (pre withdrawal) D) stage 3 (severe)

B) stage 2 (moderate)

A nurse is meeting w/ a new client at a substance use disorder clinic. The nurse should take which of the following actions during the assessment phase of the nursing process? A) formulate a diagnosis based on the information gathered B) plan interventions based on the information gathered & the diagnosis C) ask the client for information regarding their current problem, identify signs & symptoms, & use screening tools as appropriate D) Evaluate whether the plan of care has been effective

C) ask the client for information regarding their current problem, identify signs & symptoms, & use screening tools as appropriate

A nurse has been confronted about stealing & taking drugs from the narcotics cart in the medication room. Which of the following is the most serious consequences of the nurse being impaired while caring for clients? A) coworkers will notice the nurses impairment & not want to work w/ them B) the nurse may fall asleep on their shift C) clients could be harmed or die D) clients may notice the nurses impairment & sue the hospital

C) clients could be harmed or die

A nurse is providing substance use education to a group of parents. The nurse should include which of the following factors that contribute to teenagers being at risk for substance use disorder? A) although teenagers have fully developed brains, they are more susceptible to peer pressure B) teenagers have more underlying psychiatric issues than adults, making them more susceptible to addiction C) decision making, judgment, & self control are not fully mature in teenagers D) abstinence programs have the opposite effect & make teens want to drink & use drugs

C) decision making, judgment, & self control are not fully mature in teenagers

A nurse is working w/ a provider to determine which laboratory tests should be ordered for a client who is suspected of chronic alcohol use. The nurse should identify that which of the following sets of laboratory data might indicate chronic alcohol use? A) brain natriuretic peptide, cardiac enzymes, alkaline phosphate B) CBC, WBC, neutrophils. platelets C) liver panel, compressive metabolic panel, BAL/BAC, magnesium D) blood glucose level, T3, T4, thyroid stimulating hormone

C) liver panel, compressive metabolic panel, BAL/BAC, magnesium

A nurse is discussing common misconceptions regarding patients who have substance use disorder. The nurse should include which of the following as a possible consequence of a client being labeled by providers as drug-seeking? A) the client may realize that their behavior is inappropriate B) the client will ask to see what is written in their chart & sue the provider C) the client may be discharged without getting needed treatment D) the provider may be reprimanded & lose their job

C) the client may be discharged without getting needed treatment

A nurse manager is reviewing reports of a staff nurse. The reports indicate that the staff nurse has had an increase in being late & calling out sick more often. The staff nurse has been experiencing mood swings that have made it difficult for other nurses to work w/ them. Which of the following could also indicate that the staff nurse might be using substances? A) volunteering to serve on the crisis & disaster preparedness team as the triage & medication nurse B) volunteering to serve on the pharmacy error prevention committee C) volunteering to give all the narcotics doses to clients for the shift D) volunteering to reorganize the nursing station & medication room

C) volunteering to give all the narcotics doses to clients for the shift

A nurse is teaching parents of adolescents about use disorder. Which of the following information should the nurse include? A) relapse is uncommon is adolescents who achieve sobriety during their first treatment B) the effect of substance use or abuse causes a decrease in dopamine levels C) the potential to become addicted to a drug is magnified if it is taking orally D) changes in mood, decline in performance at school or work, & changes in peer group are warning signs of substance use disorder

D) changes in mood, decline in performance at school or work, & changes in peer group are warning signs of substance use disorder

A nurse is caring for a 78 year old client who is being seen for hypertension. The client has type 2 diabetes mellitus w/ neuropathy & high cholesterol. At their routine providers visit, the client reports to the intake nurse that they have been drinking alcohol more heavily lately ever since their partner passed away. One of their friends told them they should cut down on the alcohol use. What are risk factors for alcohol or substance use in the older adult population? A) belonging to community clubs or other social groups where drinking & drugs use occurs B) female gender, high socio-economic status, college graduate C) experiencing emotional instability such as anger issues & mood fluctuations D) chronic medical conditions, pain, emotional losses, male gender

D) chronic medical conditions, pain, emotional losses, male gender

A nurse is meeting w/ a new client at a substance use disorder clinic. During the meeting, the nurse observes that the patient is anxious, fidgeting in their chair, & sweating profusely. Which of the following types of data describes the clients actions? A) historical B) secondary C) subjective D) objective

D) objective

A nurse is reviewing a clients risk for substance use disorder. Which of the following information about ingestion routes accurately describes substance addiction potential? A) some routes of substance use give the addict slower, more drawn out pleasure from the drug B) taking pills orally increases risk for addiction because pills are easy to access & use C) the route does not make a difference, but the specific drug consumed is the factor D) smoking or injecting a substance increases the potential for addiction

D) smoking or injecting a substance increases the potential for addiction

Which of the following are specific risk factors for health care professionals to become addicted to alcohol or drugs? A) mandatory continuing education, license renewal, financial issues B) higher divorce rate, legal problems, disciplinary actions at work C) high incidence of risk taking behaviors, reckless health practices, work parties w/ alcohol & drugs present D) work stress & burnout, work injuries, access to drugs

D) work stress & burnout, work injuries, access to drugs