Ch. 19 - Addiction

The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase?

Adolescents

The nurse is caring for a client with chronic alcohol use disorder that is experiencing an alteration in memory function. Which laboratory result will the nurse correlate with this assessment finding?

decreased thiamine level

A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?

8

Reddening of the face and neck as a result of increased blood flow

Flushing

Dual diagnosis

The client with both substance abuse and another psychiatric illness

A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?

Short history of drug use

While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?

CIWA-Ar

A nurse has their state license suspended and is mandated to attend a drug treatment program before their license is reinstated and they can return to active duty. Which statement explains the reason the nurse became addicted to controlled substances?

"Instead of wasting an opioid, I took it to get through the day."

A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks a nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?

"It can help to prevent you from drinking."

During an assessment, a client states the inability to have long-term relationships and fears being abandoned. Which question would the nurse ask to help identify the reason for the client's feelings?

"Did your parents consume alcohol when you were growing up?"

The nurse is teaching a client about addiction. Which client statement indicates the education has been effective?

"A tolerance is built up over time, so more is needed to get the same effect."

A client with alcohol use disorder is admitted for treatment. Which statement indicates that the nurse has an issue with the client's condition?

"I have family members with the same problem."

The nurse is preparing to discharge a client recovering from an addiction to an opioid. Which statement indicates to the nurse that teaching was effective?

"I plan to attend the group meetings."

A client is receiving methadone maintenance therapy. After teaching the client about this treatment, a nurse determines that the education was successful when the client makes which statement?

"I should eat small frequent meals if I get nauseated."

The nurse is educating a client regarding the use of disulfiram as treatment for alcohol use disorder. Which statement made by the client indicates that teaching is effective?

"I will avoid all products containing alcohol."

The nurse is teaching a client admitted with acute alcohol withdrawal about medications used to prevent complications during the withdrawal from alcohol. The nurse recognizes that teaching has been effective when the client makes which statement?

"I will be given a benzodiapine over several days as a substitution for alcohol."

A client is admitted for the third time for a substance use disorder. Which statement indicates the nurse is approaching the client with an open and objective attitude?

"Sometimes it takes a few times before relapses stop occurring."

The nurse is meeting with the family of a client who uses alcohol. Which statement indicates to the nurse that the family believes a myth about alcohol use?

"They only drink after work."

A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?

"What negative consequences have resulted from your drinking?"

The nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?

"Your parent's alcohol use problem is a chronic disease but can be treated."

The nurse is caring for a client who consumes an excessive amount of alcohol. The client abruptly stopped drinking at 1300 today. What is the latest time the nurse expects the onset of delirium tremens?

0100, tomorrow

A client has been prescribed naltrexone (Trexan) for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client makes which statement(s) regarding information about the drug? Select all that apply.

1. "Using this drug will reduce the appeal of alcohol." 2. "I can take this medication once a day."

A client is brought to the emergency department by a friend who tells the staff that the friend thinks the client has overdosed on cocaine. Which finding(s) would help support this suspicion? Select all that apply.

1. Client reports chest pain 2. Seizure activity occurring 3. Heart rate of 138 beats per minute

A client is experiencing severe alcohol withdrawal. Which would the nurse identify during the assessment that correlates with the withdrawal symptoms? Select all that apply.

1. Marked diaphoresis 2. Auditory hallucinations 3. Gross uncontrollable tremors

The nurse reviews information collected from family who brought the client to the emergency department for treatment. Which treatment(s) would the nurse anticipate being prescribed for the client? Select all that apply.

1. gastric lavage 2. saline cathartic 3. activated charcoal

An adolescent reports smoking marijuana with friends during lunch time at school and taking a parent's opioid pain medication "to get high." Which factor(s) would the nurse expect to assess about the client's environment? Select all that apply.

1. high crime rates 2. high unemployment 3. substandard school systems

A nurse is performing an assessment for a client brought in with a family member that states they think the client has been using inhalants today. Which effect does the nurse observe that indicates the client has likely used inhalants? Select all that apply.

1. stumbling gait 2. euphoria 3. aggressiveness 4. dizziness

In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?

12 hours

Based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety

12-step program

The nurse is caring for a client experiencing alcohol withdrawal. Which intervention will the nurse perform to alleviate the physical effects associated with alcohol withdrawal?

Administer fixed-dose chlordiazepoxide as prescribed.

The client is brought to the emergency room with opioid overdose. After the initial assessment for central nervous system (CNS) function, what will be the nurse's priority action?

Administer naloxone.

The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse?

All the conditions are attributable to the alcohol abuse

The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?

Asians

Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?

Benzodiazepines

an episode during which the person continues to function but has no conscious awareness of their behavior at the time or any later memory of the behavior; usually associated with alcohol consumption

Blackout

The mental health nurse should focus on preventative efforts including educational interventions related to the abuse of prescription drugs on which client group?

Both genders between the age of 12 and 17

Which group could benefit most from prevention programs?

Children, prior to first use

A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?

Chlordiazepoxide

A maladaptive coping pattern on the part of family members or others that results from a prolonged relationship with the person who uses substances

Codependence

Drug classified under the Controlled Substances Act; includes opioids, stimulants, benzodiazepines, anabolic steroids, cannabis derivatives, psychedelics, and sedatives

Controlled substance

A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?

Delirium tremens

Defense mechanism; clients may deny directly having any problems or may minimize the extent of problems or actual substance use

Denial

Synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA; amphetamine-like effects, some also have hallucinogenic effects; called club drugs

Designer Drugs (Club Drugs)

The process of safely withdrawing from a substance

Detoxification

Clonidine is most effective for which symptom of opioid withdrawal?

Diarrhea

Use of a substance that results in maladaptive behavior

Intoxication

The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?

Dopamine

A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?

Elevated temperature

Behaviors that seem helpful on the surface but actually perpetuate the substance use of another; for example, a wife who calls to report her husband has the flu and will miss work when he is actually drunk or hungover

Enabling

A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class?

Hallucinogen

A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?

Hallucinogen

Ecstasy is an example of which type of substance?

Hallucinogen

Substances that distort the user's perception of reality and produce symptoms similar to psychosis, including hallucinations (usually visual) and depersonalization

Hallucinogens

The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?

Help them to identify appropriate diversional activities.

When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?

Helping the client identify positive coping mechanisms

A diverse group of drugs including anesthetics, nitrates, and organic solvents that are inhaled for their effects

Inhalants

Which characteristic of the 12-step program distinguishes it from other programs?

It is a self-help group that focuses on total abstinence.

Which medication is used to prevent alcohol withdrawal symptoms?

Lorazepam (Ativan)

A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?

Monday morning

A client with a history of alcohol use disorder has presented to the emergency department with hallucinations and relays being followed by the police. Which action will the nurse take given this information?

Monitor for Korsakoff syndrome from long-term effects of alcohol use.

A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?

Naloxone

Controlled drugs; often abused because they desensitize the user to both physiological and psychological pain and induce a sense of euphoria and well-being; some are prescribed for analgesic effects, but others are illegal in the United States

Opioids

Abuse of more than one substance

Polysubstance use

A client is brought for emergency care for symptoms that developed after ingesting mescaline, a hallucinogen. Which action will the nurse make a priority when caring for the client?

Reduce environmental stimuli.

The nurse suspects that another nurse is taking controlled substances from the narcotics drawer. Which action would the nurse take to address this issue?

Share the suspicion with the nurse manager.

Natural recovery that occurs without treatment of any kind

Spontaneous Remission

Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions.

Stimulants

- United States has one of the highest rates of adolescent drug use - Adolescent alcohol and cigarette consumption has declined in recent years - Parents, peers and education in prevention

Substance Use/Abuse

A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?

Substance abuse disorders

The nurse reviews the medical record of a client with a substance use condition. For which reason would the nurse approach the care of the client with understanding and compassion?

Substance use is a chronic recurring condition.

Administering decreasing doses of a medication, leading to discontinuation of the drug

Tapering

Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?

The client had six drinks a few hours ago.

The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?

The client most likely has a dual diagnosis since she has both a substance dependence and depression.

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

The drug helps to satisfy the craving for the opioid.

A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?

The spouse will refrain from the enabling the client's drinking behaviors.

Which medication is used to prevent Wernicke-Korsakoff syndrome?

Thiamine (vitamin B1)

A client with chronic alcoholism has been found to have Wernicke encephalopathy. This irreversible complication is characterized by what?

Thiamine, or vitamin B1, deficiency

The nurse is assessing a client who is suspected of having an alcohol use disorder. The nurse asks about daily alcohol intake. The client replies, "The important point is that if I have 10 drinks, I don't get drunk." The nurse determines the client's response as what?

This is an indication of long-term use of alcohol for this client

The need for increased amount of a substance to produce the same effect

Tolerance

Very small amounts of a substance will produce intoxication

Tolerance Break

A nurse is conducting a class for a group of high school students about marijuana use and abuse. The nurse determines that the class needs further discussion when they state which of the following?

Users of marijuana always experience relaxation and euphoria.

An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?

Verbalize feeling safe and comfortable.

High doses of alcohol produce which effect?

Vomiting

High doses of alcohol produce which effect?

Vomiting (unconsciousness and respiratory depression)

A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?

Wernicke-Korsakoff syndrome

Refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases

Withdrawal Syndrome

The nurse is working with a group of health care professionals on a program to address the use of substances in the community. Which information would the nurse emphasize to include in the program?

actions to prevent relapse

The nurse is caring for a client experiencing acute alcohol withdrawal. The nurse understands that safe withdrawal is usually accomplished by administering which class of medication to the client?

benzodiazepines

A nurse is caring for a client with an acute substance intoxication. The client's pupils are dilated, and the nurse notes the client's blood pressure is 166/108 mm Hg. Which substance is the most likely cause of the client's symptoms?

cocaine

The nurse is caring for an adult client that has been admitted to the detoxification unit. Due to acute withdrawal, what cues will the nurse likely assess?

flushed face, headache, and tremors

A nurse is preparing an inservice program about substance use disorder. Which information would the nurse include in the presentation when discussing possible contributors to the development of substance use disorder?

genetic predisposition

A client with a long history of alcohol abuse is hospitalized. The client's last drink was at noon. The nurse would anticipate symptoms of withdrawal beginning no later than what time?

midnight

An adolescent client is brought for emergency care after being found stuporous from sniffing glue. Which treatment will the nurse anticipate for the client?

oxygen therapy

A nurse is assessing a client with bizarre and aggressive behavior in the emergency department. Upon questioning, the client's partner discloses that the client had been smoking PCP. While in the emergency department, the client continues to exhibit signs of PCP-induced psychosis and needs to be physically restrained. Which nursing outcome will the nurse prioritize in the care of this client?

physical safety will be maintained and no injury will be experienced

The public health nurse is planning community education on substance use. Which will the nurse prioritize?

prevention

A nurse observes a fellow nurse colleague who has an unsteady gait and slurred speech. The nurse suspects that the colleague is impaired. Which would be the appropriate action to take?

report the nurse colleague's behavior to the supervisor on the floor