Ch. 17: Substance Use
During an assessment, a teenager reveals a 2-year history of inhalant use. Using knowledge that fumes may be inhaled through the mouth, this will achieve a state of intoxication similar to: A) Alcohol B) Cannabis C) Cocaine D) Morphine
A Fumes may be inhaled through the mouth, referred to by adolescents as "huffing," or the nose ("sniffing"), to achieve a state of intoxication similar to that of alcohol, not cannabis, codeine, or morphine.
The nurse performs motivational interviewing with a college student in the university health center regarding the student's history of binge drinking. The nurse hopes to ascertain the student's readiness to change her behavior and encourage her to make better choices related to alcohol use. The interview should begin with: A) Listening empathetically to establish trust B) Eliciting feelings about how the drinking behavior is affecting the student's life C) Noting discrepancies between attitudes toward alcohol and alcohol-associated harms D) Being supportive of the student's life goals
A Nurses in university health services are ideally positioned to identify at-risk students and use motivational interviewing to ascertain the students' readiness to change their behavior. Motivational interviewing begins by establishing trust, being an empathic listener, and instilling hope and positive regard—communication skills familiar to nurses, which are the foundation of the nurse-client relationship. Once the nurse establishes rapport, brief motivational interviewing consists of specific cognitive strategies such as eliciting feelings about how the drinking behavior is affecting the student's life, noting discrepancies between attitudes toward alcohol and alcohol-associated harms, emphasizing strengths, supporting life goals, and empathically supporting the student on ways to implement change or remaining neutral when met with ambivalence.
A nurse receives blood test results that indicate that a 14-year-old client has been using cannabis. Based on knowledge of factors that affect rate of cannabis use among youth, which would be the most effective strategy to discourage this behavior? A) Explain the risks associated with cannabis use B) Remind the client that it is still illegal in your state C) Refer the client for counseling D) Share about your own experience with drug use
A Past-month cannabis use was 10 times higher in youth who perceived there was moderate, slight, or no risk, compared with their peers who perceived great risk. Thus, explaining the risks of use might dissuade future use. The client likely already knows that it is illegal in his state. Although referring the client to counseling might be appropriate, if he is unaware of the risks associated with cannabis use, he will likely not bother to pursue it. Sharing about your own experience with drug use would not be appropriate in the context of your role as a nurse.
An older client is seeking a fourth refill on a prescription for benzodiazepines. The nurse is concerned that the client may be developing a tolerance for the drug. Which comment by the client would most confirm this concern? A) "Lately I've had to double up on my dose just for it to be effective." B) "I ran out of pills a week ago and have felt sweaty and agitated ever since." C) "I feel like I just can't function without the medicine." D) "The medicine has been wonderful. I think one more refill should do it for me."
A Tolerance is the diminished physical and/or psychological response to effects of alcohol or illicit substances. A person develops tolerance when he or she needs to use higher doses of a substance to achieve the desired effect. Withdrawal is reduction in prolonged substance use that results in problematic behavioral, physiological, and cognitive changes. Feeling like one cannot function without a substance is a sign of substance dependence. Praising the medication and requesting another refill could be a sign of substance dependence.
The nurse assesses a 33-year-old who abuses alcohol. To gauge how the client's substance use is impairing his ability to fulfill normal role functions, the nurse should use: (Select all that apply.) A) History of arrests for drunken driving B) Age at the time of first alcoholic drink C) Jobs lost due to intoxication at work and chronic absenteeism D) Failing grades in night classes at the local community college E) Blood alcohol level at time of last arrest for driving while intoxicated
A, C, D Legal, employment, or academic difficulties that have resulted from misuse are an important gauge of how substance use is impairing the client's ability to fulfill normal role functions. Age at first use of a substance is a key indicator for risk of substance dependence but would not be a good gauge for how substance use is impairing the client's fulfillment of roles. Blood alcohol level is used to establish whether someone is intoxicated, but would not be a good gauge for how substance use is impairing the client's fulfillment of roles.
In assessing a 13-year-old Native American boy who lives on a reservation, the nurse finds that he regularly drinks alcohol and smokes cannabis. He says that most of his friends do so, as well. The nurse is aware that this rate of prevalence is far higher than that for 13-year-olds of all ethnicities nationwide. Which social conditions have researchers associated with this health disparity? (Select all that apply.) A) Greater availability of cannabis from local farms B) Higher socioeconomic status C) Lower academic attainment D) Proximity to Mexico and drug gangs E) College enrollment
A, C, D Substance misuse is a major public health concern for Native American youth on reservations, where more than half of eighth graders report alcohol and cannabis use, a pronounced increase from overall national prevalence rates for eighth graders of all ethnicities. While there is no causal model to explain the higher rates of substance use among youth on reservations, social factors including greater availability from local cannabis farms, proximity to Mexico and drug gangs, lower (not higher) socioeconomic status, and lower academic attainment (not college enrollment) are some of the social conditions that researchers have associated with this pronounced health disparity.
A nurse working in the rural Southeast United States sees many young white adolescent girls in the clinic. The nurse should be aware that which type of substance use is highest among this demographic? A) Smoking cannabis B) Sniffing glue C) Injecting heroin D) Drinking alcohol
B For young adolescents, rates of inhalant use are highest for white females residing in the rural southeast (22.4%) and Mexican-American females (22.7%) living in rural parts of the western United States.
A client arrives at the clinic shaky and requesting a refill on a prescription for alprazolam (Xanax). The nurse suspects that the client might be experiencing substance withdrawal. Which comment by the client would most tend to confirm your suspicion? A) "Lately I've had to double up on my dose just for it to be effective." B) "I ran out of pills a week ago and have felt sweaty and agitated ever since." C) "I feel like I just can't function without the medicine." D) "The medicine has been wonderful. I think one more refill should do it for me."
B Withdrawal is reduction in prolonged substance use that results in problematic behavioral, physiological, and cognitive changes. Tolerance is the diminished physical and/or psychological response to effects of alcohol or illicit substances. A person develops tolerance when he or she needs to use higher doses of alcohol or illicit substances to achieve the desired euphoric effect. Feeling like one cannot function without a substance is a sign of substance dependence. Praising the medication and requesting another refill could be a sign of substance dependence.
The nurse assesses a 15-year-old client who shows some signs of possible drug addiction. The nurse reviews the client's health and family history, looking for key indicators for risk of substance dependence, such as: (Select all that apply.) A) Obesity B) Age at first use of illicit substance C) Family history of alcoholism D) Presence of a learning disability E) Early onset of diabetes
B, C In conducting a complete biopsychosocial history, two of the key indicators for risk of substance dependence are age at first use and a family history of substance use disorder. Obesity, presence of a learning disability, and early onset of diabetes are not key indicators for risk of substance dependence.
A politically active community health nurse assists in drafting state legislation for alcohol use laws. Which principles of the World Health Organization should be integrated into the draft legislation? (Select all that apply.) A) Legislation should be guided and formulated by the interests of local business owners. B) Alcohol policies should be equitable for all in the state. C) Alcohol policies should be sensitive to cultural contexts. D) Legislation should protect those with substance use disorders from serving extended prison sentences. E) Legislation should protect those exposed to the harmful effects of drinking by others.
B, C, E Public policies and interventions to prevent and reduce alcohol-related harm should be guided and formulated by public health interests, not the interests of local business owners, and based on clear public health goals and best available evidence. Alcohol policies should be equitable and sensitive to national, religious, and cultural contexts. Protection of populations at high risk for alcohol-related harm and those exposed to the harmful effects of drinking by others should be an integral part of public health policies. Populations affected by the harmful use of alcohol should have access to affordable and effective prevention and care services. Legislation should not protect those with substance use disorders from serving extended prison sentences.
The nurse works with a 16-year-old client who has an alcohol use disorder. Which mental disorder, highly correlated to substance use disorder, should the nurse also assess for in this client? A) Obsessive compulsive disorder B) Anxiety disorder C) Major depression D) Bipolar disorder
C In the United States, substance use is highly correlated with a range of mental disorders and serious psychological distress. Three times as many youth 12 to 17 years of age who were diagnosed with major depression in the past year met criteria for substance use disorder (18.2%), as compared with youth who did not have a history of mental illness (5.8%).
The nurse teaches a client about pharmacologic treatments for alcohol-dependent disorders. The client correctly understands the teaching when she tells the nurse that a medication that induces aversive effects if alcohol is consumed is: A) Naltrexone B) Acamprosate C) Disulfiram D) Buprenorphine
C Naltrexone and acamprosate have pharmacologic properties that diminish craving for alcohol, whereas disulfiram induces aversive effects if alcohol is consumed. Opioid substitution treatment consists of administering methadone or buprenorphine in prescribed doses to injection drug users in programs administered by governments.
The nurse works with a recovering heroin addict who is currently receiving opioid substitution treatment. Besides reducing his use of heroin, what additional benefits are offered by this treatment? (Select all that apply.) A) Reduction in alcohol use B) Weight loss C) Decrease in transmission of HIV D) Improving the client's overall health E) Decrease in depression
C, D Opioid substitution programs are effective in decreasing the transmission of HIV infection, reducing injecting drug use, and improving the health of people addicted to opioids. They are not associated with a reduction in alcohol use, weight loss, or a decrease in depression.
The community health nurse is concerned with the prevalence of new HIV infections in the community and understands the strong correlation between substance use disorders and HIV. Which interventions should the nurse promote in the community health clinic to best address this problem? (Select all that apply.) A) 12-step self-help groups B) Family and couples therapy C) Opioid substitution treatment D) Syringe exchange programs E) Motivational interviewing
C, D Opioid substitution treatment and syringe exchange programs have been effective in lowering the rates of HIV infection among injection drug users in both developed and developing countries. Self-help groups such as Alcoholics Anonymous are effective in assisting people in countries with high rates of alcohol abuse but would not help decrease the rate of HIV infection. Family and couples therapy also would not address the underlying problems among injection drug users that promote the spread of HIV.
A woman who is at high risk for alcohol abuse has just found out that she is pregnant. The nurse counsels her about the long-term effects of alcohol on the child. The nurse should include mention of: (Select all that apply.) A) Down syndrome B) Type 1 diabetes C) Low IQ D) Facial anomalies E) Short attention span
C, D, E Alcohol use during pregnancy is a serious public health concern because of the multiple deleterious, lifelong effects of alcohol on the child. These lifelong effects include low IQ, hyperactivity, short attention span, distinctive facial anomalies, and structural brain defects. Down syndrome is the result of a genetic defect and is not associated with alcohol use in the mother. Type 1 diabetes is also not associated with alcohol use in the mother.
The nurse assesses a 19-year-old client for alcohol abuse. Which would be the most significant risk factor for alcohol abuse in this client? A) African-American race B) Female gender C) History of type 1 diabetes D) Enrollment in college
D A major risk factor for problem drinking in young adults is enrollment in college. The significant difference (p < .05) in binge and heavy drinking between college students (39.1%) and their peers (35.4%) not enrolled in college has remained unchanged over the past decade and suggests campus cultural norms are a strong factor contributing to significantly higher health risks. Rates of binge alcohol use vary by race and ethnicity and are highest among American Indians or Alaska Natives (24.3%). Female gender and history of type 1 diabetes are not significant risk factors for alcohol abuse.
The client states a history of substance abuse but reports current abstinence. If valid, this report means that the client has not used alcohol or illicit substances in at least how many months? A) 3 B) 6 C) 9 D) 12
D If there is no use of illicit substances or alcohol in the preceding 12 months, a person is considered abstinent.
The nurse works in the ER when a client arrives with respiratory depression associated with a heroin overdose. Which medication should the nurse expect to be ordered for this client? A) Naltrexone B) Acamprosate C) Disulfiram D) Naloxone
D Naloxone is an opioid antagonist that blocks the opioid receptors and temporarily reverses respiratory depression associated with opioid overdose. Naltrexone and acamprosate have pharmacologic properties that diminish craving for alcohol, whereas disulfiram induces aversive effects if alcohol is consumed.
The nurse screens a woman who is 6 months pregnant for alcohol use. Which screening instrument should be used? A) AUDIT-C B) CAGE C) SMAST-G D) T-ACE
D The T-ACE screening instrument has been validated for use with women who are pregnant. All adults in primary care should be routinely screened for alcohol use with the AUDIT-C or CAGE questionnaire. The AUDIT-C, CAGE, and SMAST-G screening instruments are available in a pocket-sized brochure to facilitate use in all primary care settings.
The nurse works with a client who is struggling with heroin addiction. Which examination should the nurse perform to screen for a comorbidity that is highly associated with substance use disorders? A) Assessment of blood glucose level B) Bone marrow aspiration C) Magnetic resonance imaging of the brain D) Mental status examination
D There is high comorbidity of substance use disorders with major mental illness. The mental status examination is a valuable tool in identifying signs and symptoms of major mental illness that co-occur with substance use. The mental status examination can alert the nurse to cognitive changes that are the result of chronic substance use and can help differentiate symptoms from other medical conditions, such as dementia or delirium.
The nurse counsels a college student who admits to frequent binge drinking. Based on her age and environment, the most likely reason for this student's binge drinking is to: A) Deal with family dysfunction B) Cope with violence C) Escape painful emotions D) Enhance mood or affective state
D Unlike their younger peers, who may use alcoholic beverages to cope with family dysfunction, violence, or painful emotions, college students are more likely to engage in heavy or binge drinking to enhance their mood or affective state.