Chapter 14- substance abuse

A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to Alcoholics Anonymous (AA), would be most appropriate for a nurse to discuss with the client during discharge teaching? 1. To immediately attend AA meetings at least weekly. 2. To rely on an AA sponsor to help control alcohol cravings. 3. To incorporate family in AA attendance. 4. To seek appropriate deterrent medications through AA.

1 The most appropriate client outcome for the nurse to discuss during discharge teaching is attending AA meetings at least weekly. AA is a major self-help organization for the treatment of alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure.

A client diagnosed with major depression and substance use disorder has an altered sleep pattern and demands a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics decrease the production of needed liver enzymes. 3. Sedative-hypnotics lengthen necessary REM (rapid eye movement, dream) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

1 The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance and cross-tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction.

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year to feel better. Which term should the nurse use in report to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Intoxication

1 The nurse should use the term psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure (feel better) or avoid discomfort.

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

1 There is a correlation between pathological gambling and abnormalities in the neurotransmitter, dopamine. This is not the case with non-pathological gambling

Which nursing diagnosis is the priority for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1 The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: coarse tremors of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. The nurse would assess which symptoms and behaviors? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anticipation and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Compulsive gambling began in early adolescence.

1,2,4 1 In gambling disorder, the preoccupation with and impulse to gamble intensifies when the individual is under stress. 2 Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. 4 Gambling is used as a coping strategy for dealing with stress and disappointments.

Which nursing statements exemplify the process that must be completed by a nurse in the pre-introductory phase prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

1,2,4 1 This statement indicates the nurse has completed the process of reviewing attitudes and beliefs prior to caring for clients diagnosed with substance-related disorders. 2 This statement indicates the nurse completed the pre-introductory process of reviewing attitudes and beliefs. It is important for nurses to identify potential areas of need within their own attitudes and beliefs that may affect their relationships with clients diagnosed with this problem. 4 Determining the need to set boundaries is an example of a pre-introductory process of reviewing attitudes and beliefs that must be completed by a nurse prior to client care.

A nursing supervisor is offering an impaired staff member information regarding a peer assistance program. Which facts should the supervisor include? (Select all that apply.) 1. A hot-line number will be available in order to call for help. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients

1,3,5 1 Most states provide either a hot-line number that the impaired nurse may call or phone numbers of peer assistance committee members, which are made available for the same purpose 3 Peer support is provided through regular contact with the impaired nurse. 5 One of the goals of treatment is to intervene early to reduce hazards to clients. The peer assistance programs strive to intervene early, reduce hazards to clients, and increase prospects for the nurse's recovery.

A nurse is about to meet with a client suffering from codependency. Which data would the nurse expect to find during the assessment of this client? (Select all that apply.) 1. Has a long history of focusing thoughts and behaviors on other people 2. As a child, experienced overindulgent and overprotective parents 3. Is a people pleaser and does almost anything to gain approval 4. Exhibits helpless behaviors but actually feels very competent 5. Can achieve a sense of control through fulfilling the needs of others

1,3,5 1 The codependent person has a long history of focusing thoughts and behavior on other people. 3 Codependent clients are "people pleasers" and will do almost anything to get the approval of others. 5 Codependent clients achieve a sense of control when they are fulfilling the needs of others.

The nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 50 attempts within a 15-minute period. Which is the best rationale for assessing this client for substance addiction? 1. Narcotic pain medication is contraindicated for all clients with active substance use disorders. 2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. 4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

2 The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug.

A client with a history of alcohol use disorder is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client sign or symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

2 The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use.

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

2 The nurse would administer methadone and clonidine for a client who has a history of opiate withdrawal. As the dose of methadone diminishes, renewed abstinence symptoms may be ameliorated by the addition of clonidine

A nursing supervisor is about to meet with a staff nurse suspected of diverting clients' pain medications. Which assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. Is frequently absent from work 2. Experiences mood swings 3. Makes elaborate excuses for behavior 4. Frequently uses the restroom 5. Has a flushed face

2,3,4,5 2 Mood swings can be a sign of substance abuse. 3 The impaired nurse may make elaborate excuses for behavior. 4 The impaired nurse will frequently use the restroom. 5 A flushed face is a sign of drug use.

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements by nursing students about hepatic encephalopathy indicate successful teaching? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

2,4,5 2 This statement indicates that teaching has been effective because this condition results from a rise in serum ammonia, leading to impaired mental functioning. 4 The instructor should interpret this as successful teaching because neomycin and lactulose are medications used for this disorder. 5 The instructor should interpret this as successful teaching because hepatic encephalopathy is the inability of the diseased liver to convert ammonia to urea.

A nurse is preparing a staff education session about the impaired nurse and the consequences of this impairment. Which statement by a staff member indicates successful teaching? 1. "The state board of nursing must be notified with subjective documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Some state boards of nursing administer the treatment programs themselves, while others refer the nurse to other resources." 4. "After a return to practice, a recovering nurse may be closely monitored for several days."

3 3 Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period.

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and naltrexone (ReVia) 4. Haloperidol (Haldol) and ziprasidone (Geodon)

3 Lithium carbonate (Lithobid) and naltrexone (ReVia) have demonstrated some effectiveness for gambling disorder

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which response by the nurse is therapeutic? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

3 The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Codependency is a typical behavior of spouses of alcoholics. The nurse must help the wife through the stages of recovery beginning with Stage I: The Survival Stage in which the partner begins to let go of the denial that problems exist.

The client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." The nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Denial 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

3 The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements based upon the client's statement regarding lack of nutritional intake for three days. The client is exhibiting signs and symptoms of malnutrition, as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Provide thiamin supplements to prevent Wernicke-Korsakoff syndrome.

3 The priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for medication-assisted therapy in alcohol withdrawal to reduce life-threatening complications.

Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "When I can't control my cravings, I will faithfully attend Narcotic Anonymous." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

4 A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program (AA).

The nurse holds the hand of a client who is experiencing alcohol withdrawal. The nurse is assessing for which condition? 1. Emotional strength 2. Wernicke-Korsakoff syndrome 3. Tachycardia 4. Coarse tremors

4 The nurse is most likely assessing the client for coarse tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors.

Which medications would the nurse most likely administer to a client who has a history of opiate withdrawal? 1. Haloperidol (Haldol) and acamprosate (Campral) 2. Naloxone (Narcan) and naltrexone (ReVia) 3. Disulfiram (Antabuse) and lorazepam (Ativan) 4. Methadone (Dolophine) and clonidine (Catapres)

4 The nurse would administer methadone and clonidine for a client who has a history of opiate withdrawal. As the dose of methadone diminishes, renewed abstinence symptoms may be ameliorated by the addition of clonidine

Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

4 The priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for medication-assisted therapy in alcohol withdrawal to reduce life-threatening complications.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant to a client with alcohol withdrawal? 1. Antagonist treatment 2. Deterrent therapy 3. Codependency therapy 4. Medication-assisted treatment

4 Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called medication-assisted treatment