Ch 71: Caring for Clients with Chemical Dependence

A nurse is instructing a client who is to receive disulfiram. Which statement by the client demonstrates that the teaching was effective?

"I can use any antacids"

A client has been taking disulfiram and is about to stop. The nurse advises the client to avoid all forms of alcohol, including in substances like cough syrup, for a minimum of how many weeks after discontinuation of disulfiram? Fill in the blank with the correct number.

2 Weeks

A patient is admitted to the emergency room with acute alcohol intoxication. He is combative. Which of the following medications will be administered?

A sedative

An alcoholic client has been consuming excessive amounts of cola and chocolate. The health care provider advises against disproportionate use of over-the-counter preparations containing caffeine. What should the nurse tell the client about the effect of caffeine in the body?

Adds to the depressive effect of alcohol

A client who suffers from alcoholism is prescribed disulfiram. How does this medication assist the client in refraining from ingestion of alcohol?

Allows the accumulation of acetaldehyde

Which treatment is not used to manage opiate dependence?

Antabuse

A nurse is developing strategies to prevent relapse with a client who abuses alcohol. Which client intervention is important?

Avoiding people, places, and activities from the former lifestyle

A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient?

BP: 170/98, P:110, R: 20

The nurse is monitoring a client hospitalized during withdrawal from alcohol and is using the "Rule of One Hundreds." Which of the following findings is consistent with this rule? Select all that apply.

Body temperature of at least 100 degrees Pulse rate of at least 100 beats/mine

A client is admitted to the alcohol rehabilitation program. What medication will the client be prescribed to treat alcohol withdrawal syndromes?

Chlordiazepoxide (librium)

A client who has suffered bilateral fractures of the femurs in a fall undergoes a bilateral open reduction and internal fixation, and is admitted after recovering in the PACU. Twenty-four hours after admission, the client begins having hallucinations, agitation, hypertension, and profuse sweating. What would be the nurse's first step?

Consult with the physician regarding the need for a detoxification drug.

A nurse is caring for a client who's undergoing treatment for acute alcohol dependence. The client tells the nurse, "I don't have a problem. My wife made me come here." Which defense mechanism is the client using?

Denial and rationalization

A client recovering from alcohol abuse needs to develop effective coping skills to handle daily stressors. Which intervention is most useful to the client?

Discussing examples of successful coping behavior

What crimes have substance abuse as a major contributor?

Domestic Violence Child abuse Traffic and boating fatalities

A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies:

Drug tolerance

The nurse is assessing laboratory data of a client who has been complaining of gastric distress. The nurse is aware that which abnormal laboratory value may indicate that the client's gastric issues are related to chronic alcohol ingestion?

Elevated aspartate aminotransferase (AST)

The psychiatric community nurse is working with a highly culturally diverse group of mostly young adult clients who have substance abuse issues. Many clients have had difficult social circumstances and experience relapses. What would be the most appropriate nursing intervention in dealing with these clients?

Encourage motivation and confidence so that the clients can better deal with the triggers that cause them to repeat their behaviors

A client consumed alcohol almost daily while she was pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol?

Fetal Alcohol Syndrome

A 52-year-old client arrives at the emergency department via ambulance. The paramedics tell the nurse that the client drinks approximately 26 ounces of liquor per day and is suffering from alcohol withdrawal delirium. His last drink was 48 hours ago. Which symptoms would alert the nurse to the potential for delirium tremens?

Fever, hypertension, changes in level of consciousness, and hallucinations.

Which condition is not a consequence of smoking?

Gynecologic cancer

A nurse is trying to determine if a client who abuses heroin has any drug-related legal problems. Which assessment question is the best to ask the client?

Have you received any legal violations related to your drug use?

A client who has a 50-year history of smoking, along with being a recovering alcoholic who drank for 15 years, has developed significant dementia symptoms in the past 6 months. Which historical data could be significant?

Heavy alcohol ingestion >10 years

The nurse is speaking with a group of newly-recovering alcoholics and drug users in an outpatient rehabilitation program. Which of the following issues should the nurse raise before the clients leave for the day?

Help them to identify appropriate diversional activities

A client is admitted to an inpatient facility to be treated for his addiction problem. What is the role of the nurse with this diagnosis? Select all that apply.

History of drug abuse physical condition signs of toxicity monitor for suicidal ideation administer medications provide support during withdrawal

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. For which of the following will the nurse assess?

Hypertension

A 47-year-old male has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, he admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?

Imbalanced nutrition: less than body requirements related to chronic alcohol intake

When discussing methadone treatment with a client, the nurse teaches what?

It decreases the severity of heroin withdrawal symptoms

The family of a client withdrawing from heroin asks a nurse why the client is receiving naltrexone. Which response is correct?

It's used to help reverse withdrawal symptoms

Which of the following is used as a substitute for heroin in some maintenance programs?

Methadone

A client is receiving treatment for opioid toxicity. Which drug reverses opioid toxicity?

Naloxone (Narcan)

Nicotine, a legal substance that results in dependence, presents a major challenge to the health care industry. Annually, 438,000 people die to a tobacco-related complication. Which occurrence presents a similar mortality rate?

None

The nurse is performing a history and physical examination on a client with chronic alcoholism. Which of the following conditions may be attributable to the client's history of alcohol abuse?

Pancreatitis Elevated liver enzymes esophagitis

Paramedics have brought a patient to the emergency department with a suspected heroin overdose. The nurse should recognize that the patient's most acute threat to health at this time is:

Respiratory Depression

Which statement most accurately describes the etiology of substance-related disorders?

Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors.

A client tells the nurse that she went to a party and had several drinks. When she woke up the next morning, she could not remember driving home. What does the nurse suspect?

The client had a blackout

Which of the following factors 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

A client was admitted to the hospital last night with a compound fracture of the femur, sustained in a fall while intoxicated. Her condition remains relatively stable; however, she is shaky, irritable, and anxious. She tells about having vivid nightmares for two nights. The next day when the nurse returns from lunch, she finds the client restless and perspiring. Her pulse is 130. She cries, "Bugs are crawling on my bed. I've got to get out of here," and begins to thrash about. What would be the most accurate assessment of the client's situation?

The client is experiencing symptoms consistent with withdrawal delirium

A client is now experiencing acute alcohol withdrawal. What complication should the nurse anticipate based on the present condition?

The increased potential for seizures and hallucinations

A family expresses concern when a family member withdrawing from alcohol is given lorazepam. What information should be given to the family about the medication?

The medication is given for a short time to help the client complete the withdrawal process

A client with alcoholism is showing cognitive changes consistent with dementia. The nurse is aware that what nutritional deficiency may be contributing to the client's problems?

Thiamine

Wernicke-Korsakoff syndrome is a neurologic condition that can result from heavy drinking. Which of the following medications is used to prevent Wernicke-Korsakoff syndrome?

Thiamine (Vitamin B1)

A client drinks 24 oz of vodka every day and has been gradually increasing to this level over the past 2 to 3 years. The client continues to maintain a job and function in activities of daily living, relationships, and other aspects. Which of the following terms should the nurse use to describe the client's drinking behavior?

Tolerance

There are four steps toward the development of chemical dependence. Which term does not represent one of the steps?

Tolerance

A client is trying to stop smoking and reports concern to the nurse about gaining weight as a result. Which response from the nurse is most appropriate?

Typically, clients gain 5 to 10 lbs in the first year after smoking cessation

The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:

Underestimate the amount of consumed

A client 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 client agrees to take disulfiram. The nurse will teach the patient that the combination of alcohol and disulfiram will cause which of the following?

Vomiting

Smoking cessation programs are most successful when they include which components? Select all that apply.

counseling and behavior modification pharmacologic therapy