Chapter 31: Addiction and Substance-Related Disorders

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

Disulfiram should not be administered until a client has abstained from alcohol for at least how long?

12 hours

Which of the following is the best description of the term substance use disorders, according to the American Psychiatric Association?

Is an umbrella term for substance abuse and substance dependence

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 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."

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?"

A client will be taking disulfiram after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective?

"Drinking alcohol while taking disulfiram can cause dangerous symptoms."

As a component of the standard nursing admission assessment at the hospital, a nurse is using the CAGE tool. Which of the following questions will the nurse ask the client?

"Have you ever felt like you should cut down on your drinking?"

A nurse is caring for a client with substance use disorder. The nurse determines that education was successful when the client makes which statement?

"I am not alone with addiction because it affects every class and gender."

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 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 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."

The nurse is educating a client with alcoholism that has been in rehabilitation for two weeks to prepare for discharge. Which statement made by the client indicates that education was effective and the client is best prepared for discharge?

"In order to give myself the best chance for sobriety, I will abstain from alcohol."

The nurse is counseling a client that has maintained sobriety for 90 days. The client states, "I still have cravings and don't know how I am going to stay sober for the rest of my life. What if I can't do it in the long run?" Which is the most therapeutic response by the nurse?

"Let's look at this in the short term and determine what you can do to stay sober today."

The nurse is conducting a health promotion class on drug awareness with a group of junior high school students. Which of the following teaching points should the nurse include in this session?

"Marijuana use can result in psychological dependence, which can have a very negative effect on your life."

The nurse is interviewing family members of a client being treated for substance use disorder. Which statement by a family member would alert the nurse to the possibility of codependency?

"My sibling would not drink as much if their spouse was more understanding."

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. Upon admission, he tells the nurse, "I am so ashamed." Which of the following would be the best response by the nurse?

"Tell me what has happened since your last admission."

A client is readmitted to the substance use disorder program for the second time in 6 months for alcohol use disorder. On admission, the client tells the nurse, "I am so ashamed." What should the nurse reply?

"Tell me what has happened since your last admission."

The spouse of a client who is alcoholic asks the nurse how to respond to the client in a helpful way when the client is disruptive in family life. Which is the nurse's best response?

"Try to maintain a normal home environment for yourself and the children."

The family of a client admitted for substance use disorder is being taught about enabling behaviors. Which statement(s) by the family demonstrates their understanding of the information provided by the nurse? Select all that apply.

"We can no longer make excuses or lie for them." "We will have to be more assertive and less passive." "We are not responsible for their money failures."

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 with alcohol abuse is to receive disulfiram. The client's last drink was at 4 PM. The client should receive the medication no earlier than at which time?

4 AM

The nurse is caring for a client with alcohol use disorder that is acutely intoxicated. Which action will the nurse perform to treat the Wernicke-Korsakoff syndrome the client is experiencing?

Administer Vitamin B1.

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.

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. The nurse recognizes these symptoms as typical of which of the following?

Alcohol withdrawal syndrome

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

Which group could benefit most from prevention programs?

Children, prior to first use

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

The nurse is assessing a client with a history of alcohol abuse. Which of the following is the most common defense mechanism used by a client diagnosed with a substance use problem?

Denial

A client is brought to the emergency department by law enforcement after suspicion of driving under the influence. A blood alcohol level is drawn and is found to be 0.10 mg%. Which of the following would the nurse expect to assess?

Difficulty coordinating movements

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

Dopamine

Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which situation?

Having several clients complain that their pain medication is not working

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.

A client has a blood alcohol level of 0.05%. The nurse would expect which behavior to occur?

Impaired judgment

Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply.

It is a legal medication. It is controlled by a health care provider. It is available in tablet form.

Which medication is used to prevent alcohol withdrawal symptoms?

Lorazepam (Ativan)

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.

Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors

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 is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client?

Monitor respiratory function.

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

A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with the therapist, the nurse states the nurse is nervous about how coworkers will respond to the nurse now that "they all know I'm a drunk." Which diagnosis best targets the problem implicit in the nurse's remarks?

Situational low self-esteem related to medical condition

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.

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.

The nurse is working with a client with alcohol use disorder that has difficult behaviors to manage. Which action by the nurse is a priority to effectively care for this client?

The nurse must recognize their own beliefs, backgrounds, and attitudes related to substance use disorder.

The nurse is caring for a client with a substance use disorder. When speaking with the client's spouse, the nurse finds the family member hides the client's disorder from others and helps cover for the client when the client is hungover. Which statement is true?

The spouse is acting in a codependent manner.

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

Thiamine, or vitamin B1, deficiency

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.

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 with delirium tremens (DTs). Which development constitutes a medical emergency?

development of seizure activity

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