Addictive Substances Practice Questions (Test #5, Fall 2020)

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Phenytoin (Dilantin)

B

Symptoms of alcohol withdrawal include: a. euphoria, hyperactivity, and insomnia. b. depression, suicidal ideation, and hypersomnia. c. diaphoresis, nausea and vomiting, and tremors. d. unsteady gait, nystagmus, and profound disorientation.

C

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? a. Increased heart rate and blood pressure b. Tremors, insomnia, and seizures c. Incoordination and unsteady gait d. Nausea and vomiting, diarrhea, and diaphoresis

D

Which of the following should lead the nurse to suspect that a client is addicted to heroin? 1.Hilarity. 2.Aggression. 3.Labile mood. 4.Hypoactivity.

4 The client who is addicted to heroin is most likely to exhibit hypoactivity. Initially, the client feels euphoric. This is followed by drowsiness, hypoactivity, anorexia, and a decreased sex drive. Hilarity, aggression, and a labile mood usually are not associated with heroin addiction

The client's friend reports that the client has been taking about eight "reds" (800 mg of secobarbital [Seconal]) daily, besides drinking more alcohol than usual. The client's friend asks anxiously, "Do you think she will live?" Which of the following responses by the nurse is most appropriate? 1."We can only wait and see. It's too soon to tell." 2."Do you know her well? She's so young." 3."She is very ill and may not live. Some don't pull through." 4."Her condition is serious. You sound very worried about her."

4 When a friend asks whether a seriously ill client will live, it is best for the nurse to respond by explaining the seriousness of the client's condition and acknowledging the friend's concern. This type of comment does not offer false hope. Telling the friend to wait and see and that it is too soon to tell is a stereotypical statement that offers no support to the friend. Asking the friend to describe his or her relationship with the client ignores the friend's concern and does not focus on the problem. Simply saying that the client is very ill and may not live and that some don't pull through is harsh and not supportive.

A client states to the nurse, "I'm not going to any more Narcotics Anonymous meetings. I felt out of place there." Which of the following responses by the nurse is best? 1."Try attending a meeting at a different location; you may feel more comfortable there." 2."Maybe it just wasn't a good day for you. Everybody has bad days now and then." 3."Perhaps you weren't paying close enough attention to what they were saying." 4."Sometimes the meetings can seem like a waste of time, but you need to attend to stay clean.

1 Suggesting that the client try attending a meeting at a different location is a supportive, positive response and encourages the client to continue participating in treatment. Saying, "Maybe it just wasn't a good day for you," or "Perhaps you weren't paying close enough attention," places blame on the client and is not helpful. The statement, "Sometimes the meetings can seem like a waste of time, but you need to attend to stay clean," diminishes the importance of the self-help group and offers little support to the client.

A client who has experienced the loss of her husband through divorce, the loss of her job and apartment, and the development of drug dependency is suffering situational low self-esteem. Which of the following outcomes is most appropriate initially? 1.The client will discuss her feelings related to her losses. 2.The client will identify two positive qualities. 3.The client will explore her strengths. 4.The client will prioritize problems"

1 The most appropriate initial outcome for the client is to discuss thoughts and feelings related to her losses. The nurse should help the client identify and verbalize her feelings so that she can externalize her thoughts and emotions and begin to deal with them. This prevents the client from internalizing feelings, which leads to depression and self-harm. The ability to identify two positive qualities, explore strengths, and prioritize problems would be appropriate after the client has explored her thoughts and feelings, gained awareness of the issues, and then can participate in the treatment plan.

Before his hospitalization, a client needed increasingly larger doses of barbiturates to achieve the same euphoric effect he initially realized from their use. From this information, the nurse develops a plan of care that takes into account that the client is likely suffering from which of the following? 1.Tolerance. 2.Addiction. 3.Abuse. 4.Dependence.

1 Tolerance for a drug occurs when a client requires increasingly larger doses to obtain the desired effect. Therefore, the plan of care would address the client's state of tolerance. The term addiction refers to psychological and physiologic symptoms indicating that an individual cannot control his or her use of psychoactive substances. This term has been replaced with the term dependence. Abuse refers to the excessive use of a substance that differs from societal norms. Drug dependence occurs when the client must take a usual or increasing amount of the drug to prevent the onset of abstinence symptoms, cannot keep drug intake under control, and continues to use even though physical, social, and emotional processes are compromised.

A client approaches the medication nurse and states, "I can't believe you are NOT helping me with my cravings for my fentanyl patches! When I got off alcohol 2 years ago, they gave me naltrexone for my cravings, and it really helped. I can't stand the cravings and back pain anymore, and I'm getting angry." Which of the following responses by the nurse would be helpful for this client? Select all that apply. 1."Naltrexone does help decrease the cravings for alcohol." 2."Naltrexone can interfere with opiate cravings in some clients." 3."Cravings are hard to deal with, especially when you are in pain too." 4."I hear your frustration about how your detoxification is going." 5."I am positive naltrexone can help with your cravings for fentanyl." 6."I can ask your physician if he thinks naltrexone might help you."

1, 2, 3, 4, 6. Acknowledgment of the client's frustration, pain, and cravings is important to decrease the client's anger. Naltrexone can help with detoxification from alcohol and opiates. Asking the physician about the possibility of adding naltrexone is appropriate. The nurse can never promise that a medication will help this client, since naltrexone is effective with only 20% to 30% of clients with opiate cravings.

A client is being admitted to the addictions unit for a confirmed and long-term addiction to Xanax (alprazolam). She continues to strongly deny her addiction, stating she was prescribed the Xanax to control her "panic attacks." Which of the following procedures would be the most important during the admission process? Select all that apply. 1.Assess the client for suicide, escape, and aggression risks. 2.With the client present, search the client's clothes and belongings for contraband and restricted items. 3.Initiate withdrawal precautions. 4.Explain the unit routine and types of groups. 5.Obtain a urine specimen for a urine drug screen.

1, 2, 3, 5. Clients who deny an addiction and the need for treatment can be at risk for a suicide attempt, efforts to escape the unit, and aggression directed at staff. A contraband search is a safety measure to look for concealed drugs and dangerous items. Depending on the last use of the substance, withdrawal symptoms can begin quickly. A urine drug screen is crucial to determine what other substances the client may be using that may cause other withdrawal symptoms. Explaining the unit routines and groups can wait until the client is calmer and more receptive

A client is brought to the emergency department by a friend who states, "He was using a lot of heroin until he ran out of money about 2 days ago." The nurse judges the client to be in opioid withdrawal if he exhibits which of the following? Select all that apply. 1.Rhinorrhea. 2.Diaphoresis. 3.Piloerection. 4.Synesthesia. 5.Formication.

1,2,3 Symptoms of opioid withdrawal include yawning, rhinorrhea, sweating, chills, piloerection (goose bumps), tremors, restlessness, irritability, leg spasms, bone pain, diarrhea, and vomiting. Symptoms of withdrawal occur within 36 to 72 hours of usage and subside within a week. Withdrawal from heroin is seldom fatal and usually does not necessitate medical intervention. Synesthesia (a blending of senses) is associated with lysergic acid diethylamide use, and formication (feeling of bugs crawling beneath the skin) is associated with cocaine use.

When developing a teaching plan for a group of middle school children about the drug 3,4-methylenedioxymethamphetamine (Ecstasy), what information should the nurse expect to include? Select all that apply. 1.Using Ecstasy is similar to using speed. 2.Ecstasy is used at all-night parties. 3.Teeth grinding is seen with cocaine, not Ecstasy use. 4.It can cause death. 5.It reduces self-consciousness.

1,2,4,5 Ecstasy is chemically related to methamphetamine (speed) and is used at all-night parties also known as "raves" to enhance dancing, closeness to others, affection, and the ability to communicate. Euphoria, heightened sexuality, disinhibition, and diminished self-consciousness can occur. Adverse effects include tachycardia, elevated blood pressure, anorexia, dry mouth, and teeth grinding. Pacifiers, including candy-shaped pacifiers and lollipops, are used to ease the discomfort associated with teeth grinding and jaw clenching. Hyperthermia, dehydration, renal failure, and death can occur.

The client is fidgeting and has trouble sitting still. He has difficulty concentrating and is tangential. Which of the following interventions should help decrease this client's level of anxiety? Select all that apply. 1.Refocusing attention. 2.Allowing ventilation. 3.Suggesting a time-out. 4.Giving intramuscular medication. 5.Assisting with problem solving.

1,2,5 The client is exhibiting symptoms of moderate anxiety. At this level of anxiety, the nurse should help the client to decrease anxiety by allowing ventilation, crying, exercise, and relaxation techniques. The nurse would further assist the client by refocusing his attention, relating behaviors and feelings to anxiety, and then assisting with problem solving. Oral medication may be needed if the client's anxiety is prolonged or does not decrease with the nurse's interventions. Suggesting a time-out and giving intramuscular medication are possible interventions for a client whose anxiety level is severe.

In consultation with his outpatient psychiatrist, a client is admitted for detoxification from methadone. He states, "I got addicted to morphine for my chronic knee pain. Methadone worked for a long time. Since I had my knee replacement surgery 3 months ago and physical therapy, I don't think I need methadone any more." It is important to discuss which of the following pieces of information with this client? Select all that apply. 1."Detoxification will likely occur with slowly decreasing doses of methadone." 2."Oxycodone will be available if needed for break-through-pain." 3."You will be monitored closely for withdrawal symptoms and treated as needed." 4."Physical therapy and nonchemical pain management techniques can be prescribed if needed." 5."If you have knee stiffness or pain, it is likely to be managed by nonnarcotic pain medicines."

1,3,4,5 Since methadone is an addictive medication, the client will be gradually tapered off of it, while monitoring him for withdrawal symptoms. Any residual pain is likely to be controlled with other pain management techniques and nonnarcotic pain medication. It is very unlikely that oxycodone would be prescribed PRN since it is a very addictive medication.

A school nurse is planning a program for parents on "Drugs Commonly Abused by Teenagers." Which of the following information should be included about inhalants? Select all that apply. 1.Monitor for paper bags and rags that may have been used for breathing inhalants. 2.Brain damage is unlikely with the use of inhalants. 3.Use of inhalants by teens is on the decline. 4.Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit. 5.Inhalants usually cause depression of the central nervous system. 6.The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol propellants from spray cans, and anesthetics/gases.

1,4,5,6 The nurse should instruct the parents to monitor their children for use of paper bags or rags. The nurse should present information about brain damage from inhalants including damage to the frontal lobe, cerebellum, and hippocampus, and that death is possible. Rather than use being on the decline, teenagers are experimenting even more with many types of inhalants, such as Freon, ground-up candy disks, and spray cleaners for computer and TV screens.

A client has been taking increased amounts of alprazolam (Xanax) for about 6 months for anxiety. She asks the nurse how she can "get off the Xanax." The most accurate answer by the nurse is which of the following? 1."There will be an immediate discontinuation of the Xanax and haloperidol (Haldol) will be available if needed." 2."Instead of Xanax, you will take lorazepam (Ativan) in decreasing doses and frequency over a period of 3 to 4 days." 3."The Xanax will be tapered down over a period of 48 hours." 4."Xanax will be available on an as-needed basis for 4 to 5 days.

2 Ativan, as opposed to Xanax, is available in dosage ranges that allow more gradual tapering down of doses over the 3 to 4 days. Haldol is not effective for benzodiazepine withdrawal. Tapering Xanax in 48 hours is too rapid. Offering Xanax as a PRN does not deal with the need to gradually reduce the dose and frequency over time.

Which of the following should the nurse use as the best measure to determine a client's progress in rehabilitation? 1.The kinds of friends he makes. 2.The number of drug-free days he has. 3.The way he gets along with his parents. 4.The amount of responsibility his job entails.

2 The best measure to determine a client's progress in rehabilitation is the number of drug-free days he has. The longer the client abstains, the better the prognosis is. Although the kinds of friends the client makes, the way he gets along with his parents, and the degree of responsibility his job requires could influence his decision to stay clean, the number of drug-free days is the best indicator of progress.

A client states that her "life has gone down the tubes" since her divorce 6 months ago. Then, after she lost her job and apartment, she took an overdose of barbiturates so she "could go to sleep and never wake up." Which of the following statements by the nurse should be made first? 1."It seems as if your self-esteem has been affected by all your losses." 2."I know you took an overdose of barbiturates. Are you thinking of suicide now?" 3."Helplessness is common after losing a job. Are you having trouble making decisions? "4."You sound hopeless about the future since your divorce."

2 The highest priority is assessing for suicide risk. When the client is safe, then the self-esteem, helplessness, and hopelessness issues can be addressed.

When caring for a client who has overdosed on phencyclidine (PCP), the nurse should be especially cautious about which of the following client behaviors? 1.Visual hallucinations. 2.Violent behavior. 3.Bizarre behavior. 4.Loud screaming.

2 The nurse must be especially cautious when providing care to a client who has taken phencyclidine (PCP) because of unpredictable, violent behavior. The client can appear to be in a calm state or even in a coma, then become violent, and then return to a calm or comatose state. Visual hallucinations, bizarre behavior, and loud screaming are associated with PCP-intoxicated clients. However, the unpredictable, violent behavior presents a major issue of safety for clients and staff.

A client who chronically snorts cocaine is brought to the emergency department due to a cocaine overdose. The client is experiencing delusions, hallucinations, mild respiratory distress, and mild tachycardia initially. The nurse should do which of the following? Select all that apply. 1.Induce vomiting. 2.Place seizure pads on the bed. 3.Administer PRN haloperidol (Haldol) as prescribed. 4.Monitor for respiratory acidosis. 5.Encourage deep breathing. 6.Monitor for metabolic acidosis.

2,3,4,5,6 The cocaine was not swallowed, so inducing vomiting is not indicated. A cocaine overdose can produce seizures, paranoia, and respiratory and/or metabolic acidosis. Deep breathing will help decrease the respiratory distress and pulse rate.

A client is returning to the primary care physician's office for follow-up on his diagnosis of coronary artery disease. After all the appropriate exams and assessments are completed, the nurse asks the client about how well he is sleeping. The client states, "Oh, that's not a problem anymore. I take a couple of my wife's Valiums (diazepam) and sleep like a baby." Which of the following information should the nurse obtain? Select all that apply. 1.The reason the client's wife is taking Valium. 2.The dose of the Valium he is taking and how long he has been taking it. 3.Exactly how many Valiums he takes at night and during the day, 4.Whether he intends to stop the Valium use. 5.What was interfering with his sleep prior to starting the Valium.

2,3,5 The dose, length of use, and the number of Valiums taken per day are important for assessing the severity of the substance abuse and potential withdrawal. Determining sleep interferences is necessary for treating the underlying causes of the insomnia. The reason his wife takes Valium is confidential information and not critical to his situation. Getting off the Valium is essential, not an option, especially with his cardiac issues. This needs to be done safely if he has been taking it for more than a week or 2

A client with a cocaine dependency is irritable, anxious, highly sensitive to stimuli, and overreactive to clients and staff on the unit. Which of the following actions is most therapeutic for this client? 1.Secluding and restraining the client as needed. 2.Telling the client to stay in his room until he can control himself. 3.Providing the client with frequent "time-outs." 4.Confronting the client about his behaviors.

3 Providing frequent "time-outs" when the client is highly anxious, sensitive, irritable, and over-reactive is needed to calm the client and reduce the possibility of escalating behaviors and violence. Secluding and restraining the client is not appropriate and would only be used if the client was threatening others and other alternative actions had been unsuccessful. Telling the client to stay in his room until he can control himself is unrealistic and futile because the client cannot eliminate behaviors induced by chemicals. Confronting the client about his behaviors would most likely lead to aggression and possibly violent behavior.

The nurse is speaking to a sixth grade class about drugs. A student states, "I know someone who smokes marijuana and he says it's safe." The nurse should tell the student: 1."Marijuana isn't safe, and it is illegal." 2."Do you really believe him?" 3."That drug causes more damage to your body than regular cigarettes." 4."Marijuana usage can lead to using other chemicals."

3 The statement that marijuana causes more damage to your body than regular cigarettes is a direct, correct, educational response to the student's statement that does not decrease the student's or the friend's self-worth. Marijuana causes harmful pulmonary effects, weakens heart contractions, causes immunosuppression, and reduces serum testosterone and sperm count. Telling the student that marijuana is unsafe and illegal, or that using marijuana leads to using other chemicals, does not provide the student with factual information to answer the student's question. Asking whether the student really believes the friend challenges the student and may lead to defensive behavior.

A young client is being admitted to the psychiatric unit after her obstetrician's staff suspected she was experiencing a postpartum psychosis. Her husband said she was doing fine for 2 weeks after the birth of the baby, except for pain from the C-section and trouble sleeping. These symptoms subsided over the next 4 weeks. Then 3 days ago, the client started having anxiety, irritability, vomiting, diarrhea, and delirium, resulting in her inability to care for the baby. Then the husband says, "I saw that my bottles of alprazolam and oxycodone were empty even though I haven't been taking them." In what order of priority from first to last should the nurse do the following? 1. Call the physician for prescriptions for appropriate treatment for opiate and benzodiazepine withdrawal. 2. Immediately place the client on withdrawal precautions. 3. Confirm with the client that she has in fact been using her husband's medications. 4. Assess the client for prior and current use of any other substances.

3. Confirm with the client that she has in fact been using her husband's medications. 4. Assess the client for prior and current use of any other substances. 2. Immediately place the client on withdrawal precautions. 1. Call the physician for prescriptions for appropriate treatment for opiate and benzodiazepine withdrawal. It crucial to confirm that the client was It crucial to confirm that the client was taking her husband's opiates and benzodiazepines and that her symptoms are due to the sudden withdrawal from these medications. It is also important to know if she has been using other substances (such as alcohol) that may cause other withdrawal symptoms. Even before calling the physician for prescriptions, the nurse can initiate withdrawal precautions for client safety.

A client in the emergency department is diagnosed as having amphetamine psychosis. The nurse should take all of the following actions in which order of priority from first to last? 1. Transfer the client to the psychiatric unit. 2. Monitor cardiac and respiratory status. 3. Place seizure pads on the bed. 4. Administer IM haloperidol (Haldol) as prescribed.

3. Place seizure pads on the bed. 2. Monitor cardiac and respiratory status. 4. Administer IM haloperidol (Haldol) as prescribed. 1. Transfer the client to the psychiatric unit. The risk of seizures is an immediate safety issue, and the nurse should first place seizure pads on the bed. Amphetamine overdose can produce cardiac arrhythmias and respiratory collapse; the nurse should next monitor the client. Then the Haldol is indicated to antagonize the amphetamine affects. When the client is medically stable, the nurse can transfer the client to a psychiatric unit. Haldol would be stopped as the psychotic symptoms subside

Which of the following statements by the nurse is most appropriate when addressing a client with a barbiturate overdose who awakens in a confused state and exhibits stable vital signs? 1."I'm here to help you beat your drug habit. But it's you who will need to work hard." 2."It's time to get straight and stay clean and put an end to your torture." 3."I'm glad you pulled through; it was touch and go with you for a while." 4."You're in the hospital because of a drug problem; I'm one of the nurses who will help you."

4 For a client who is confused when awakening after taking a large dose of barbiturates, the nurse should speak in concrete terms using simple statements in a calm, nonjudgmental, gentle manner to assist the client with cognitive-perceptual impairment, enhance understanding, and decrease anxiety. The other statements contain abstract information and some slang terms that may further confuse the client and thus increase the client's anxiety.

A client is being admitted to the hospital following an inadvertent overdose with oxycodone. He reveals that he has chronic back pain that resulted from an injury on a construction site. He states, "I know I took too much oxycodone at once, but I can't live with this pain without them. You can't take them away from me." Which of the following responses by the nurse is most appropriate? 1."Once you are tapered off the oxycodone, you will find that nonaddictive pain medicines will be enough to control your pain." 2."You are going to be switched from the oxycodone to methadone for long-term pain management. 3.The oxycodone will be stopped tomorrow, but you will have lorazepam to help you with the withdrawal symptoms. 4.Your pain will be controlled by tapering doses of oxycodone, with other pain management strategies and medicines.

4 Tapering doses of oxycodone, pain management strategies, and other pain control medicines are found to be the most helpful with opiate addictions resulting from chronic pain. Nonaddictive (over-the-counter) medicines alone are generally insufficient for chronic pain management. Methadone is an addictive opioid that involves substituting one addiction with another, so now clients are being detoxed off Methadone as well. Lorazepam may help with anxiety during withdrawal from opiates, but it does not control the other symptoms of opiate withdrawal.

The nurse notices that a client recovering from a barbiturate overdose spends most of his time with other young adults who have substance-related problems. This group of clients is a dominant force on the unit, keeping the nondrug users entertained with stories of their "highs." Which of the following methods is best to use when dealing with this problem? 1.Providing additional recreation. 2.Breaking up drug-oriented discussions. 3.Speaking with the clients individually about their behavior. 4.Discussing the behavior at the daily community meeting.

4 The best method to deal with the problem is to discuss observations with clients at the daily community meeting because the problem involves all of the clients and this provides them with the opportunity to offer their views. Peer pressure is valuable in confronting self-defeating and destructive behaviors. Providing additional recreation avoids or ignores the problem and is damaging to all clients because it decreases trust in the nurse. Breaking up drug-oriented discussions would not be sufficient to stop the behavior. Speaking with the clients individually about their behavior is not as effective as dealing with the problem openly and directly with everyone.

When teaching a client who is to receive methadone therapy for opioid addiction, the nurse should instruct the client that methadone is useful primarily for which of the following reasons? 1.It is not an addictive substance. 2.A maintenance dose is taken twice a day. 3.The client will no longer be addicted to opioids. 4.The client may work and live normally.

4 The client takes methadone primarily to be able to work, live normally, and function productively without the mental and physical deterioration caused by opioid addiction. Methadone lessens physiologic dependence on opioids and is used to prevent withdrawal symptoms. Methadone, a substance similar to morphine, is an addictive substance; the client is still considered addicted to opioids. Because methadone has a long half-life of 15 to 30 hours, it can be taken once a day on an outpatient basis.

A client walks into the clinic and tells the nurse she has run out of money for crack, has crashed, and wants something to help her feel better. Which of the following is most important for the nurse to assess? 1.Suspiciousness. 2.Loss of appetite. 3.Drug craving. 4.Suicidal ideation.

4 The nurse assesses the client for feelings of depression and suicidal ideation. After experiencing an instantaneous high from crack, a crash immediately follows and the client has an intense craving for more crack. A crash commonly leads to a cocaine-induced depression when additional crack is unavailable. At times, the depression is so severe that users attempt suicide. Although suspiciousness, loss of appetite, and drug craving are also associated with cocaine use, they are less of a priority than suicidal ideation

A client recovering from a drug overdose is interacting with the nurse and recounting her exploits at numerous parties she's attended. Which of the following actions is most therapeutic? 1.Allowing the client to continue with her stories. 2.Telling the client you've heard the stories before. 3.Questioning the client further about her exploits. 4.Directing the conversation to realistic concerns.

4 The nurse directs the conversation to realistic concerns or issues to decrease denial and focus on rebuilding a substance-free life. Allowing the client to continue with the stories or questioning the client further about her exploits reinforces the denial. Telling the client you've heard the stories before is nondirective. Additionally, these actions do nothing to help the client focus on rebuilding a substance-free life.

A client with symptoms of amphetamine psychosis that are improving is anxious and still experiencing some delusions. When developing the client's plan of care, which of the following measures should the nurse include? 1.Assign the client to a group meeting about the physiologic effects of drugs. 2.Advise the client to watch television. 3.Wait for the client to approach the nurse. 4.Invite the client to play a game of ping-pong with the nurse.

4 The nurse should invite the client who is anxious to participate in an activity that involves gross motor movements. Doing so helps to direct energy toward a therapeutic activity. Appropriate activities include walking, riding a stationary bicycle, or playing volleyball. Assigning the client to an educational group is not helpful because the anxious client would be unable to sit in a group setting and concentrate on what was occurring in the group. Watching television may be too stimulating for the client, possibly increasing anxiety. Additionally, the client may be too anxious to sit and focus. Waiting for the client to approach the nurse is not helpful or appropriate. The nurse is responsible for initiating contact with the client.

An unconscious client in the emergency department is given IV naloxone (Narcan) due to an overdose of heroin. Which of the following would indicate a therapeutic response to the Narcan? Select all that apply. 1.Decreased pulse rate. 2.Warm skin. 3.Dilated pupils. 4.Increased respirations. 5.Consciousness.

4,5 Naloxone is an opioid antagonist used to treat an opioid overdose. Within a few minutes, the client should have an increase of respirations to near normal and become conscious. With a heroin overdose, the pulse is not significantly affected, the skin becomes warm and wet, and the pupils are dilated. With naloxone the skin would return to a normal temperature and become dry. The pupils also would react normally and the pulse would not be decreased.

A 68-year-old client is admitted to the addiction unit after treatment in the Emergency Department for an overdose of Percocet (oxycontin). Her son calls the unit and expresses intense anger that his mother is being treated as a "common street addict." He says she has severe back pain and was given that prescription by her doctor. "She just accidentally took a few too many pills last night." Which reply by the nurse is most therapeutic? 1."I understand that your mother may not have intentionally taken too many pills. This medication can cause one to forget how many have been taken." 2."It may be appropriate for your mother to be referred to a pain management program." 3."Unfortunately, it is fairly common for clients with pain to increase their use of pain pills over time." 4. "I can hear how upset you are. You sound very concerned about your mother."

4. Acknowledging the client's son's feelings is the most therapeutic intervention because he is not likely to hear the nurse's information until his anger and other feelings are addressed and subside. Then it is important to acknowledge that oxycontin, especially in older clients, can interfere with remembering how many pills were taken. It is common for clients with chronic pain to inadvertently overuse or become addicted to pain medications. Pain management programs help clients to withdraw from the offending medication and start on a multifaceted system for controlling the pain.

Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? a. Search his room for evidence. b. Ask, "Have you been drinking alcohol, Dan?" c. Send a urine specimen from Dan to the lab for drug screening. d. Tell Dan, "These guys cannot come to the unit to visit you again."

c

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work, Dan." c. "Get real, Dan! You're a boozer and you know it!" d. "Why do you think your boss sent you here, Dan?"

B

From which of the following symptoms might the nurse identify a chronic cocaine user? a. Clear, constricted pupils b. Red, irritated nostrils c. Muscle aches d. Conjunctival redness

B

When assessing a client with possible alcohol poisoning, the nurse should investigate the client's use of which of the following substances while drinking alcohol? 1.Marijuana. 2.Lysergic acid diethylamide. 3.Peyote. 4.Psilocybin.

1 Smoking marijuana while using alcohol can lead to alcohol poisoning because marijuana masks the nausea and vomiting associated with excessive alcohol consumption. Marijuana contains tetrahydrocannabinol (THC), which is responsible for suppressing nausea. With dangerous levels of alcohol in the body, respiratory depression, coma, and death can occur. Lysergic acid diethylamide, peyote, and psilocybin do not contain THC.

The friend of a client brought to the emergency department states, "I guess she had some bad junk (heroin) today." The client is drowsy and verbally nonresponsive. Which of the following assessment findings is of immediate concern to the nurse? 1.Respiratory rate of 9 breaths/min. 2.Urinary retention. 3.Hypotension. 4.Reduced pupil size.

1 A respiratory rate of less than 12 breaths/min is cause for concern because of central nervous system depression. Respiratory depression and arrest is the primary cause of death among clients who abuse opioids. Peripheral nervous system effects associated with opioid abuse include urinary retention, hypotension, reduced pupil size, constipation, and decreased gastric, biliary, and pancreatic secretions. Pinpoint pupils are a sign of opioid overdose. However, respiratory depression is the immediate concern.

A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? a. The client abuses amphetamines and anxiolytics. b. The client abuses alcohol and cocaine. c. The client is psychotic. d. The client abuses narcotics and marijuana.

A

Which of the following should the nurse expect to assess for a client who is exhibiting late signs of heroin withdrawal? 1.Vomiting and diarrhea. 2.Yawning and diaphoresis. 3.Lacrimation and rhinorrhea. 4.Restlessness and irritability.

1. Vomiting and diarrhea are usually late signs of heroin withdrawal, along with muscle spasm, fever, nausea, repetitive sneezing, abdominal cramps, and backache. Early signs of heroin withdrawal include yawning, tearing (lacrimation), rhinorrhea, and sweating. Intermediate signs of heroin withdrawal are flushing, piloerection, tachycardia, tremor, restlessness, and irritability.

Which of the following liquids should the nurse administer to a client who is intoxicated on phencyclidine (PCP) to hasten excretion of the chemical? 1.Water. 2.Milk. 3.Cranberry juice. 4.Grape juice.

3 An acid environment aids in the excretion of PCP. Therefore, the nurse should give the client with PCP intoxication cranberry juice to acidify the urine to a pH of 5.5 and accelerate excretion.

After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? 1.Cerebral edema. 2.Kidney failure. 3.Seizure activity. 4.Respiratory depression

4 After administering naloxone, the nurse should monitor the client's respiratory status carefully because the drug is short acting and respiratory depression may recur after its effects wear off. Cerebral edema, kidney failure, and seizure activity are not directly related to opioid overdose or naloxone therapy.

A client brought by ambulance to the emergency department after taking an overdose of barbiturates is comatose. The nurse should assess the client for: 1.Kidney failure. 2.Cerebrovascular accident. 3.Status epilepticus. 4.Respiratory failure.

4 Because barbiturates are central nervous system depressants, the nurse should be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate overdose. Kidney failure, cerebrovascular accident, and status epilepticus are not associated with barbiturate overdose.

Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? a. "They claim they will help me stay sober." b. "I'll dry out in AA, then I can have a social drink now and then." c. "AA is only for people who have reached the bottom." d. "If I lose my job, AA will help me find another."

A

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is: a. denial. b. projection. c. displacement. d. rationalization.

A

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Lab reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addictions unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink. b. 2 to 3 days after the last drink. c. 4 to 5 days after the last drink. d. 6 to 7 days after the last drink

A