ATI Substance-Related and Addiction Disorders

A nurse is caring for a newly admitted client who is concerned about their ability to continue to practice nursing. 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. Nurses' Notes 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, click to specify if the action is anticipated or unexpected for the client. 1. State board of nursing will investigate 2. Immediate loss of license 3. Enrollment into a monitoring/recovery program 4. Criminal charges and arrest

1. Anticipated 2. Unexpected 3. Anticipated 4. Unexpected

A nurse is caring for a client in detoxification unit. Admission note Day 1 :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 treatment for alcohol use disorder. Blood alcohol level at time of accident was 0.33 mg/dL. Reports drinking "hard liquor" since age 14. Also states, "I drink about 10 to 12 drinks of vodka a day." Nurse's Note Day 1 0800:Client reports drinking "several shots of vodka yesterday". Tremulousness of hands noted. Client refuses food currently, stating, "I am nauseated." 1600:Assisted client to complete the Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-Ar) document. Client's score is 32. Complete the following sentence by using the list options 1. The client is at the highest risk for developing: a. moderate withdrawal b. severe withdrawal c. mild withdrawal 2. As evidenced by the client's a. nausea b. CIWA-AR score c. tremulousness

1. b. severe withdrawal 2. b. CIWA-AR score

A nurse is caring for a client. Nurses' Notes Admission - Day 1: 19-year-old client admitted for evaluation of potential substance use disorder. Client lives with adult parents and is enrolled in college courses leading to an associate degree in accounting. Client regularly attends spiritual services with their father. Client acknowledges that they have been dating the same individual for 18 months, and "we plan to move into together as soon as we have the money." Day 2: 1500:Client revealed during group therapy session that they were physically abused by a family member while they were an adolescent. Also stated, "My mom is depressed and has been taking pills for a long time." Client also acknowledged that their favorite uncle has been "smoking dope and taking pain pills for as long as I can remember." Select the 2 findings that require immediate follow-up. a. Statement regarding clients uncle b. Living arrangements c. Spiritual affiliations d. Revelation of what occurred while client was an adolescent e. Educational status f. Relationship status

a, d

A nurse is meeting with 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 and 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 with a new client at a substance use disorder clinic. The nurse and the client are discussing the clients care plan, including medication, follow up appointment, scheduling, and 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 addiction? a. Positive relationships b. Married parents c. Living in the Midwest population of the U.S. 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 and 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 and is returning to work three months later with 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 no administer any type of medications

a. The nurse can care for clients but cannot administer narcotics

A nurse is caring for a client in a substance use disorder clinic. The client was referred by their healthcare provider, who is concerned that they might have a problem with misusing prescription pain medication. Although the client has kept this appointment, they insist there is nothing wrong with them, and that they do not have a problem with their pills. Which statement by the client may 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 with them and haven't gotten my annual screening this year." c. "I try to get out and take walks when the pain lets up." d. "I am planning on moving in with my sister so she can help me."

b. "My provider is just mad that I have missed three appointments with them and haven't gotten my annual screening this year."

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 programs, cognitive-behavioral therapy, support groups c. Intensive, long-term residential treatment d. Art therapy, music therapy, yoga

b. 12-step programs, cognitive-behavioral therapy, support groups

Which of the following is a guiding principles for nurses when providing care to a client 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, healthcare providers, need to treat their clients who have addictions with empathy and compassion c. The underlying etiology of addiction in unknown d. Addiction is caused by cognitive deficits in the brain, which results in the client's inability to change

b. Addiction is a complex brain disorder, healthcare providers, need to treat their clients who have addictions with empathy and 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 temperature, increased, respirations, irritability, and 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 caring for a client who is experiencing withdrawal from alcohol. The nurse should use which of the following assessment tools in their treatment for this client? a. AUDIT b. CIWA-AR c. CAGE d. MAST

b. CIWA-AR

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 and addiction? a. Serotonin b. Dopamine c. Norepinephrine d. Y-aminobutyric acid

b. Dopamine

A nurse is meeting with an established client at a substance use disorder clinic. The client has been in treatment for six months. In this meeting, the client shares with the nurse that their partner previously would bail them out of jail when they were arrested for DUI. The client says their partner would also call into the workplace and tell the supervisor that the client was too ill to come to work when they were hung over from drugs or alcohol. The partner's behavior is indicative 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. Parkinson's disease, tardive dyskinesia, brain swelling d. Lupus and other autoimmune disorders

b. Hepatitis, pancreatitis, cirrhosis of the liver

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 with a high blood alcohol content level. The provider fears that the client may go into withdrawal and require medical supervision. The clients manifestations now include anxiety, tremors, BP 166/100 mm Hg, and 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 with a new client at a substance use disorder clinic. The client should take which of the following actions during the assessment phase of the nursing process? a. Formulate a diagnosis based in the information gathered b. Plan interventions based on the information gathered and the diagnosis c. Ask the client for information regarding their current problem, identify signs and symptoms, and 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 and symptoms, and use screening tools as appropriate

A nurse has been confronted about stealing and taking drugs from the narcotics cart in the medication room. Which of the following is the most serious consequence of the nurse being impaired while caring for clients? a. Coworkers will notice the nurse's impairment and not want to work with them b. The nurse may fall asleep on their shift c. Clients could be harmed or die d. Clients may notice the nurse's impairment and 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, and self-control are not fully mature in teenagers

c. Decision-making, judgment, and self-control are not fully mature in teenagers

A nurse is working with the provider to determine which laboratory test 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. BNP, cardiac enzymes, alkaline phosphatase b. CBC, WBC, neutrophils, platelets c. Liver panel, compressive metabolic panel, BAL/BAC, magnesium d. Blood glucose level, T3, T4, TSH

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 and sue the provider c. The client may be discharged without getting needed treatment d. The provider may be reprimanded and 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 and calling out sick more often. The staff nurse has been experiencing mood swings that have made it difficult for other nurses to work with them. Which of the following could also indicate that the staff nurse might be using substances? a. Volunteering to serve on the crisis and disaster preparedness team as the triage and medication nurse b. Volunteering to serve on the pharmacy error prevention commitee c. Volunteering to give all the narcotics doses to clients for the shift d. Volunteering to reorganize the nursing station and medication room

c. Volunteering to give all the narcotics doses to clients for the shift

A nurse is teaching parents of adolescence about substance use disorder. Which of the following information should the nurse include? a. Relapse is uncommon in 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 taken orally d. Changes in mood, decline in performance at school and work, and changes in peer group are warning signs of substance use disorder

d. Changes in mood, decline in performance at school and work, and 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 two diabetes, mellitus with neuropathy and 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 older adult population? a. Belonging to community clubs or other social groups where drinking and drug use occurs b. Female gender, high socio-economic status, college graduate c. Experiencing emotional instability such as anger issues and mood fluctuations d. Chronic medical conditions, pain, emotional losses, male gender

d. Chronic medical conditions, pain, emotional losses, male gender

A nurse is meeting with a new client at a substance use disorder clinic. During the meeting, the nurse observes that the patient is anxious, fidgeting in their chair, and 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 and 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 healthcare 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. Higher incidence of risk-taking behaviors, reckless health practices, work parties with alcohol and drugs present d. Work stress and burnout, work injuries, access to drugs

d. Work stress and burnout, work injuries, access to drugs