Assignment 3: Chap 49 (Opioids) & Chap 58 (SUD)

A postsurgical client has been provided with a morphine patient-controlled analgesic (PCA) but has expressed reluctance to use it for fear of becoming addicted. How can the nurse best respond to this client's concerns? "It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction." "It's important that you accept that your current need to control your pain is more important than fears of becoming addicted." "If you do become addicted, we'll make sure to provide you with the support and resources necessary to help you with your recovery." "You don't need to worry. It's actually not true that you can get addicted to the medications we use in a hospital setting."

"It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction." Addiction to opioids is a rare occurrence among hospital clients who do not have a history of drug abuse. It would be inappropriate to downplay the client's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction.

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." "Whatever the reason for your alcoholism, you need to quit drinking. It will kill you at this rate." "You are an alcoholic because you choose to drink." "There is no proof that alcoholism is hereditary."

"Many studies say that certain genes can cause alcoholism." Genetic factors also play an important role in drug dependence. Certain genes may predispose a person to, or protect the person from alcoholism. Several studies emphasize the effects of heredity and maintain that the disease of addiction is a consequence of genetic deficiencies in brain tissues or neurotransmitters.

A client tells a nurse, "I'm not going to have health problems from smoking marijuana." Which response by the nurse is most accurate? "Marijuana can cause reproductive and other problems later in life." "Smoking marijuana isn't as dangerous as smoking cigarettes." "Evidence shows it isn't associated with health problems." "Some people have minor or no reactions to smoking marijuana."

"Marijuana can cause reproductive and other problems later in life." Marijuana causes cardiac, respiratory, immune, and reproductive health problems. The residues from marijuana are more toxic than those from cigarettes. All people who smoke marijuana have symptoms of intoxication.

Chap 49: When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time? 1 to 2 minutes 10 to 15 minutes 15 to 30 minutes 30 to 60 minutes

1 to 2 minutes Naloxone is capable of restoring respiratory function within 1 to 2 minutes of administration. The shorter the time to restoring respiration the less time the client has to depend on manual or mechanical ventilation and the better the outcome for the client.

The nurse should share with the client receiving intravenous (IV) morphine that maximum relief of pain will occur in what time frame? 10 to 20 minutes 3 to 5 minutes 30 to 45 minutes 5 to 10 minutes

10 to 20 minutes After IV injection of morphine, maximal analgesia and respiratory depression usually occur within 10 to 20 minutes.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct? After surgery, a client may feel nauseated as a side effect of the anesthesia. Suction equipment should be placed in all client rooms as a standard of care postoperatively. This is a precaution in case the client begins to choke when resuming a general diet. Abrupt reversal of opioid-induced respiratory depression may cause vomiting.

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.

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? Blood pressure Brain Cardiovascular Liver

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.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do? Monitor blood pH level. Continue administering the prescribed drug. Increase the drug dosage level to be administered. Coach the client to breathe.

Coach the client to breathe. Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. The nurse should make efforts to arouse the client and coach him or her to breathe. The nurse need not monitor the blood pH level of the client, continue administering the prescribed drug, or increase the drug dosage level to be administered when caring for a client with a lowered breathing pattern because these interventions will not help increase the client's breathing rate.

Nurses can help prevent drug abuse by all of the following EXCEPT: Using nondrug measures when possible. Teaching clients about drugs prescribed for them. Demanding drug testing for all clients. Administering drugs appropriately.

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.

Which neurotransmitter is most likely responsible for the rewarding and reinforcing effect of cocaine? Serotonin Acetylcholine Dopamine Epinephrine

Dopamine Dopamine is the neurotransmitter that is most likely responsible for the rewarding and reinforcing effects of cocaine. Serotonin, epinephrine, and acetylcholine are not responsible for the rewarding and reinforcing effect of cocaine.

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine? Drowsiness Paresthesia in lower extremities Increased intracranial pressure Occipital headache

Drowsiness Dizziness, drowsiness, and visual changes are common side effects. If any of these occur, avoid driving, operating complex machinery, or performing delicate tasks. If these effects occur in the hospital, the side rails on the bed may be raised for your own protection. Morphine does not generally cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.

Health care professionals are considered to be at high risk for development of substance abuse disorders, at least partly because of what factor? Low cost Lax regulations related to use Knowledge of the risks involved Easy access

Easy access Health care professionals (e.g., health care providers, pharmacists, nurses) are considered to be at high risk for development of substance abuse disorders, at least partly because of easy access.

Which behavior in a client who abuses alcohol indicates a nutrition-related knowledge deficit? Taking vitamin and mineral supplements Eating only one adequate meal each day Eating large amounts of fiber Avoiding foods high in fat

Eating only one adequate meal each day If the client eats only one adequate meal each day, there will be a deficit of essential nutrients. It is appropriate for the client to take vitamin and mineral supplements to prevent deficiency in these nutrients. Avoiding foods high in fat content and consuming large portions of foods containing fiber indicate the client has good knowledge about nutrition.

A woman comes to the emergency department reporting that she thinks she was date raped. She states that she cannot remember anything and is extremely sleepy. "I think someone put something in my drink." What drug should the nurse suspect was most likely to be put in her drink? Heroin Ketamine Gamma hydroxybutyrate MDA

Gamma hydroxybutyrate Gamma hydroxybutyrate (GHB) causes memory loss and somnolence and is commonly used as a date rape drug. Ketamine causes disorientation and loss of sensation, but not memory loss. MDA or ecstasy causes loss of memory and hallucinations, but not memory loss. It is not commonly used as a date rape drug. Heroin does not cause amnesia and is not commonly used as a date rape drug.

An client admitted to your emergency department (ED) is experiencing hallucinations. The friend who brought him to the ED indicates that the client has used recreational drugs in the past but has not done so for many weeks. Which of the following drugs can trigger recurrent hallucinations? Heroin Cocaine Lysergic acid diethylamide (LSD) Marijuana

Lysergic acid diethylamide (LSD) LSD is a potent hallucinogenic that alters sensory perceptions and thought processes. Adverse reactions include "flashbacks," which are characterized by psychological effects and hallucinations that may recur days, weeks, or months after the drug is taken.

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? Diarrhea Bradycardia Nausea Slight headache

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 who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term? Opiate naive Opiate tolerant Opiate agonistic Opiate intolerant

Opiate naive An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.

Which drug would be classified as a hallucinogen? PCP heroin amyl nitrate rohypnol

PCP PCP is a hallucinogen. Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: alertness and improve memory function. a return to normal respiratory rate, rhythm, and depth. a reduction in the client's rating of their pain. management of alcohol withdrawal symptoms.

a return to normal respiratory rate, rhythm, and depth. The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

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

chlordiazepoxide Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants. Varenicline and bupropion are used for smoking cessation. Cannibus is medical marijuana and not used for acute alcohol withdrawal.

A client, being treated for the effects of alcoholism, has begun naltrexone therapy. When assessing this client's laboratory findings, the nurse should prioritize what value? liver function tests (LFTs) white blood cell (WBC) differential creatinine clearance coagulation tests

liver function tests (LFTs) A black box warning states that it is necessary to obtain periodic liver function tests during naltrexone therapy and discontinue therapy at signs of increasing hepatic impairment. Because of this warning, LFTs would be more important than creatinine clearance, WBCs, or coagulation tests.

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." "It involves the unpleasant symptoms that result when you stop taking the drug." "It is the physiologic adaptation to chronic use of a drug." "It is the decreased effect of the drug that occurs with extended use."

"It involves feelings of satisfaction and pleasure from taking the drug." 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. Physiologic adaptation to chronic use of a drug is physical dependence. Withdrawal results in unpleasant symptoms that occur when a physically dependent person stops taking a drug. Tolerance causes a decrease in the effects of a drug in a drug-dependent person, requiring increased doses to achieve the desired psychological effects or to avoid withdrawal.

A client has been deemed a candidate for methadone therapy. What instruction should the nurse provide when preparing the client for this treatment plan? "The doctor will prescribe 1 weeks' worth of methadone at a time." "For the first few weeks, you'll need to come to the outclient clinic for an intravenous (IV) dose of methadone." "You'll need to come to the clinic to get your daily dose of methadone." "You can take your methadone pills at any time, but it's important that it be on an empty stomach."

"You'll need to come to the clinic to get your daily dose of methadone." Methadone is usually given in a single, daily oral dose at an outclient methadone clinic. Neither IV dosing nor food restrictions are required. Dosing is provided on a daily basis to avoid abuse behaviors.

A client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action? Offer an ice pack and reassess the client's respiratory status in 30 minutes Inform the client that morphine would cause excessive respiratory depression and offer non-pharmacologic interventions Administer the morphine as prescribed and monitor the client's respiratory status closely Contact the care provider to seek direction

Administer the morphine as prescribed and monitor the client's respiratory status closely A respiratory rate of 14 breaths per minute is lower than expected, but is not low enough to warrant withholding a client's medication. The nurse should give the medication and monitor the client closely. There is no clear need to contact the provider.

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery? Take as little pain medication as possible to prevent addiction. Ask for pain medication before the pain gets severe. Wait as long as possible for pain medication; it will work more effectively. Request your pain medication whenever it is available to you.

Ask for pain medication before the pain gets severe. The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.

A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates? Assess the client's vital signs hourly. Delay the ordered dose if respirations are below 15 bpm. Assess the respiratory rate before giving a dose of opiates. Give a dosage only if you think it is necessary.

Assess the respiratory rate before giving a dose of opiates. Check the rate, depth, and rhythm of respirations before each dose. If the rate is fewer than 12 per minute, delay or omit the dose and report to the health care provider. Vital signs do not need to be assessed hourly. Give the medication as scheduled.

The nurse is caring for a postoperative client receiving an opioid medication for pain management. The nurse finds the client lethargic with a respiratory rate of 6 breaths per minute. Which of the following actions should be performed first? Attempt to arouse the client and coach his or her breathing pattern. Initiate a code to obtain help to resuscitate the client. Monitor the client's pain level for the remainder of the shift. No action is needed but continue to monitor the client periodically.

Attempt to arouse the client and coach his or her breathing pattern. Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. This can be alarming if the respiratory rate the nurse has been monitoring has been rapid because of anxiety and pain. The first step is to make efforts to arouse the client and coach his or her breathing pattern, if possible. It would be important to administer an opioid antagonist as well. A code is not required at this time but action is required above simply monitoring the client's pain level.

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Codeine Morphine Hydromorphone Fentanyl

Fentanyl, PATCH

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic? It has a short half-life and is less likely to accumulate, causing toxicity or overdosage. It is metabolized by the liver. It is excreted by the kidney. It has a long half-life and will manage bone pain more effectively.

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage. When opioids are needed, those with short half-lives (e.g., oxycodone, hydromorphone) are used because they are less likely to accumulate.

The nurse is admitting a patient with acute alcohol intoxication. What is the priority intervention for this patient? Administer benzodiazepines to prevent withdrawal. Plan the discharge to a rehabilitation facility. Maintain a patent airway. Observe for signs and symptoms of gastrointestinal (GI).

Maintain a patent airway. Initial nursing interventions in acutely intoxicated patients are generally directed toward preventing life-threatening or debilitating effects from the substance itself or its withdrawal. The acutely intoxicated person may not be able to protect his or her airway, so doing so is a priority in this situation.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan? Clients experience more adverse effects when PCA is used. Clients can override the lockout interval if needed when a PCA is used. Use of PCA requires a greater amount of opioid. Many postoperative clients require less opioid when PCA is used.

Many postoperative clients require less opioid when PCA is used. Many postoperative clients require less opioid when PCA is used, which leads to fewer adverse effects. The nurse can also set the lockout interval, which the client cannot override when PCA is used.

What information is most important to teach a client who abuses prescription drugs? The client should consult a health care provider before using a drug Consider if family members influence the client to use drugs Herbal substitutes are safer to use Medication should be used only for the reason prescribed

Medication should be used only for the reason prescribed Drug abusers usually take prescribed drugs for reasons other than those intended primarily to self-medicate or experience a sense of euphoria. The safety and efficacy of most herbal remedies hasn't been established. Sometimes, over-the-counter medications are necessary for minor problems that don't require consulting with a provider. There may be a family history of substance abuse, but that isn't a priority when planning nursing care.

A nurse has administered an opioid to a patient. What nursing interventions should the nurse perform if the patient shows a decrease in respirations? Instruct the patient to restrict his consumption of liquids. Instruct the patient to avoid any kind of exercise. Monitor and encourage patient to cough and breathe deeply every two hours. Instruct the patient to take complete bed rest.

Monitor and encourage patient to cough and breathe deeply every two hours. The nurse should encourage the patient to cough and breathe deeply every two hours if the patient shows a decrease in respirations after the administration of opioid analgesics. The nurse need not instruct the patient to restrict his consumption of liquids to help him cope with the effects of an ineffective breathing pattern. The nurse should perform tasks such as getting the patient out of bed and encouraging therapeutic activities such as leg exercises (when ordered); therefore, the nurse should not instruct the patient to avoid any kind of exercise or to take complete bed rest.

The client in labor receives morphine every 2 hours to manage labor pain. After 22 hours of labor the woman delivers a healthy neonate. What is the nurse's priority action related to the newborn? Administer naloxone. Monitor for withdrawal syndrome. Assess for congenital anomaly. Monitor for opioid effects.

Monitor for opioid effects. Morphine, meperidine, and oxymorphone are often used for analgesia during labor. The mother should be monitored closely for adverse reactions, and, if the drug is used during a prolonged labor, the newborn infant should be monitored for opioid effects. Naloxone would only be given if the newborn displays opioid effects. Withdrawal syndrome would not be seen with less than 24 hours of use. Every newborn is assessed for congenital anomalies but this would not be related to administration of morphine to the mother and so would not be the highest priority.

A patient with respiratory depression is administered an opioid antagonist by the nurse. What ongoing assessment should the nurse perform when administering the opioid antagonist to the patient? Monitor vital signs every 5 to 15 minutes. Teach different breathing patterns to the patient. Monitor the blood pH level of the patient. Review allergy history and other treatment modalities.

Monitor vital signs every 5 to 15 minutes. The ongoing assessment performed by the nurse when administering an opioid antagonist to the patient involves monitoring the vital signs of the patient every 5 to 15 minutes. Monitoring the blood pH level of the patient is not a part of the ongoing assessment. Reviewing the allergy history and other treatment modalities and coaching different breathing patterns to the patient are pre-administration assessments that are performed before the administration of the drug; they are not ongoing assessments.

Which of the following medication is a narcotic antagonist? Naloxone (Narcan) Oxycodone (Oxycontin) Methadone (Dolophine) Clonidine (Catapres)

Naloxone (Narcan) Narcan is a narcotic antagonist. Dolophine is a synthetic narcotic. Catapres is a alpha-adrenergic blocker. Oxycontin is a opiate drug.

Chap 58: SUD: Which of the following is a clinical manifestation of alcohol withdrawal? Dry skin Bradycardia Seizures Hypotension

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

A client experiencing alcohol withdrawal is upset about going through detoxification. Which of these goals is the priority? The client will commit to a drug-free lifestyle The client will drink plenty of fluids on a daily basis The client will make a personal inventory of strengths The client will work with the nurse to remain safe

The client will work with the nurse to remain safe The most important goal is client safety. Although drinking enough fluids, identifying personal strengths, and committing to a drug-free lifestyle are important goals, promoting client safety must be the nurse's first priority.

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 helps in the treatment of coexisting diseases, such as cardiac problems and hypertension The medication is given for a short time to help the client complete the withdrawal process The medication promotes a sense of wellbeing during the client's difficult withdrawal period The medication will help the client forget about the physical sensations that accompany alcohol withdrawal

The medication is given for a short time to help the client complete the withdrawal process Lorazepam is a short-acting benzodiazepine that may be given for 1 week to help the client in alcohol withdrawal. However, there's some debate over its use due to a potential risk for cross-addiction. The medication isn't given to help forget the experience; it lessens the symptoms of withdrawal. It isn't used to treat coexisting cardiovascular problems or promote a sense of well-being.

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 will soon develop physical dependence on other substances in this class of drug. The patient has developed a psychological dependence for marijuana. The patient has developed a physical dependence on marijuana. The patient is tolerant to the effects of the marijuana.

The patient has developed a psychological dependence for marijuana. Psychological dependence, thought by some experts to be the most important factor in addiction, involves the compulsive use of and craving for a drug. It results from the direct influence of drugs on the brain chemistry. The drug causes an altered state of consciousness and distorted perceptions that are pleasurable and satisfying to the user. Patients with a psychological addiction are motivated by the feelings the drug provides, rather than the body's need of the drug.

A patient takes an antihypertensive medication for hypertension and drinks alcohol regularly. What is important for this patient to understand about the interaction of the alcohol and antihypertensive medications? The alcohol will render the antihypertensive medication ineffective. The patient may have significant orthostatic hypotension and must be careful when rising. The combination of the alcohol and antihypertensive drug may cause the patient to have seizure activity. The combination of the alcohol and the antihypertensive medication may cause a rebound hypertensive crisis.

The patient may have significant orthostatic hypotension and must be careful when rising. Antihypertensive medication can cause an additive hypotensive effect and blood pressure should be monitored. Explain strategies for coping with orthostatic hypotension.

The nurse is taking a health history froma patient in the clinic and asks about the use of alcohol. The patient states that he drinks approximately a case of beer on some weekends. What does the nurse understand about this type of substance use? This patient has a cross dependence and most likely abuses other substances. This patient is addicted to alcohol and will have withdrawal symptoms if he does not have the alcohol. This patient has developed a tolerance to alcohol and needs more to become intoxicated. This patient abuses alcohol on weekends; this is considered substance abuse.

This patient abuses alcohol on weekends; this is considered substance abuse. Substance abuse is the inappropriate and usually excessive self-administration of a drug substance for nonmedical purposes.

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. Methadone is an ineffective drug. Methadone is expected to be soon banned in the United States. Methadone has a short duration of action.

Using methadone maintenance may lead to a dependence on methadone. Methadone is an opioid with a dependence-producing liability. Although oral methadone dosing suppresses opioid withdrawal symptoms and the drug has a long duration of action, there is a risk of the client developing 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? Dependence results in the feeling that control over drug use has been lost. Laboratory findings are congruent with frequent intoxication. There is a need to increase frequency of medication usage. Using the drug creates the feeling of satisfaction and pleasure.

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. Needed increase in drug usage is generally associated with physiological dependence. The other options are also related directly to physiological dependency.

A hospital client's pain is rated at 9/10 and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. Before administering the medication, the nurse should: ensure the client is aware of NSAID alternatives to this narcotic. ensure that there is naloxone available at the bedside. assess the client's apical heart rate for one minute. assess the client's baseline respiratory rate.

assess the client's baseline respiratory rate. The nurse should check the client's rate, depth, and rhythm of respirations before each dose. Bradycardia would contraindicate safe use, but this does not necessarily require one-minute auscultation of a client's heart rate. Naloxone should be available, but does not need to be at the client's bedside. Teaching about alternatives would depend on the client's status, the current prescriptions and the client's pain level.

A 28-year-old patient comes into the emergency department with chest pain. The client's blood pressure is 170/108, heart rate 116, and respiratory rate 32. The client states having "used drugs." The nurse would question the client about the use of: benzodiazepines. barbiturates. opioids. cocaine.

cocaine. The most commonly abused CNS stimulants include cocaine and methamphetamine. These CNS stimulants initially increase heart rate and blood pressure. Excess amounts can cause insomnia, hypertension, and cardiovascular problems.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain: codeine. fentanyl. meperidine. hydromorphone.

codeine Typically, codeine or hydrocodone are used to relieve coughing.

A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding: genetic factors. the client's perception of the admitting problem. drug use. family history of substance abuse.

drug use. Substance dependence denotes a maladaptive pattern of use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the resulting negative effects.

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. increased appetite. stupor. bradycardia.

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 methamphetamine. nicotine. cocaine. marijuana.

marijuana. The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.

Which client would the nurse identify as being opioid naive? person who routinely takes opioids individual who is physically dependent on opioids one who does not routinely take opioids one who is psychologically dependent on opioids

one who does not routinely take opioids Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.

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 psychological adaptation that results in feelings of satisfaction and pleasure physiologic adaptation requiring increased dosages of medication psychological adaptation that results in unpleasant symptoms when the drug is stopped

physiologic adaptation that results in unpleasant symptoms when the drug is stopped Physical dependence involves physiologic adaptation to chronic use of a drug so that unpleasant symptoms occur when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Attempts to avoid withdrawal symptoms reinforce psychological dependence and promote continuing drug use and relapses to drug-taking behavior. Tolerance is often an element of drug dependence in which increasing doses are required.

The nurse caring for a client suspected of ketamine abuse should focus on what characteristic behavior? increased physical strength catatonia euphoria sensory hallucinations

sensory hallucinations Ketamine is a general anesthetic that is chemically related to PCP and used during induction or maintenance of general anesthesia. Ketamine causes distorted senses and perceptions as well as dissociative reactions. These effects produce a high risk of injuries. Abnormal strength, euphoria, and catatonia are not characteristic effects of this medication.

A client discusses how drug addiction has made life unmanageable. Which information does the client need to start coping with the drug problem? how environmental stimuli serve as drug triggers how to accomplish family of origin work the addiction process and tools for recovery how peers have committed to sobriety

the addiction process and tools for recovery When the client admits life has become unmanageable, the best strategy is to teach about the addiction, how to obtain support, and how to develop new coping skills. Information about how peers committed to sobriety would be shared with the client as the treatment process begins. Family of origin work would be a later part of the treatment process. Initially, the client must commit to sobriety and learn skills for recovery. Identifying how environmental stimuli serve as drug triggers would be a later part of the treatment process.

While caring for a client who is prescribed an opioid antagonist for treatment of respiratory depression caused by opioid therapy, the nurse would assess the client for which adverse reaction? Select all that apply. tremors fever nausea tachycardia diarrhea

tremors nausea tachycardia The nurse should monitor for tachycardia, tremors, and nausea in the client because these are the adverse reactions associated with the use of opioid antagonists. The other adverse reactions include sweating, vomiting, and increased blood pressure. The nurse need not monitor for fever or diarrhea because these are not adverse reactions caused by opioid antagonists.