chapter 71 prep u test 3 ; )

A nurse is collecting data from a client with a history of cocaine abuse. Which condition might typically be found with this client?

Perforated nasal septum

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." Explanation: Antacids don't interact with disulfiram. The client should avoid anything containing alcohol, including aftershave lotion and some cough medicines and mouthwashes.

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

Counseling and behavior modification, and pharmacologic therapy are included in successful smoking cessation programs.

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

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 Antabuse can cause dangerous symptoms."

A client who abused alcohol for more than 20 years is diagnosed with cirrhosis of the liver. Which statement by the client shows that teaching has been effective?

"If I decide to stop drinking, my health may improve."

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."

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 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?

1. Elevated liver enzymes 2. Esophagitis 3. Pancreatitis

A nurse is teaching a community class about the patterns of substance abuse. Place the patterns that the nurse would review in the correct sequence, from least to greatest severity.

1. Experimentation 2. Habituation 3. Dependence 4. Addiction

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 Explanation: CNS stimulants like cocaine initially increase heart rate and blood pressure. Cocaine impairs the uptake of norepinephrine and epinephrine by presynaptic nerve endings, thus activating the adrenergic systems and causing hypertension, tachycardia, and vasoconstriction.

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

Chlordiazepoxide (Librium)

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

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)

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.

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

It decreases the severity of heroin withdrawal symptoms.

A client has come to the clinic with a fever and sore throat. This is his first visit in 18 months. The nurse notices that the client has acne, lesions, and scratch marks. Additionally, the client's teeth are broken, rotting, and discolored; the client's chart shows no indication of any previous tooth problems. He also weighs 20 lbs less than at his last appointment. What type of addiction would the nurse suspect may be apparent in this client?

Methamphetamine Explanation: Methamphetamine users may develop acne and be covered with multiple scratched lesions. Some users have tactile hallucinations and believe that insects are crawling under their skin, which causes them to scratch their face, hands, and arms. The constriction of blood vessels makes the resulting lesions slow to heal. Methamphetamine use also causes the salivary glands to dry out, leading to a wearing away of the tooth enamel from acids in the mouth. Oral tissues decay from impaired blood supply. This condition is sometimes referred to as ''meth mouth'' because of the characteristic appearance of broken, discolored, and rotting teeth. Extreme weight loss is also common.

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

Naloxone (Narcan)

The nurse in the emergency department has just administered flumazenil (Romazicon) to a client who is experiencing respiratory depression related to an overdose of a benzodiazepine. The nurse is aware that because this client has a long-term dependency on benzodiazepines, the nurse must assess the client for what symptom?

Seizure activity

A patient is admitted to the emergency room suffering from symptoms of alcohol withdrawal. What symptom of withdrawal is the priority to prevent?

Seizures

A client with alcoholism has just completed a residential treatment program. What can this client reasonably expect?

She'll need ongoing support to remain abstinent.

Which statement about the pathophysiology related to substance abuse and chemical dependence is correct?

Stimulants such as caffeine, nicotine, cocaine, and amphetamines affect levels of norepinephrine, dopamine, and acetylcholine. Central nervous system depressants are chemical agents that slow brain and physiologic activity. Depressant drugs such as alcohol, heroin, and other opiates and barbiturates cause effects similar to those of gamma-aminobutyric acid, endorphins, and enkephalins.

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. Explanation: Disulfiram may not be administered to a client who is acutely intoxicated. A family history of alcoholism, marijuana use, and binge drinking do not preclude the use of the drug.

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

A client who has bilateral fractures of the femurs from a fall undergoes a bilateral open reduction and internal fixation, and is admitted after recovering in the PACU. Twenty-four hours after admission to the unit, the client begins to experience hallucinations, agitation, hypertension, and profuse sweating. What might be causing these signs and symptoms?

alcohol withdrawal

Which treatment is not used to manage opiate dependence?

antabuse

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

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?

he nurse should assess the client's history of drug abuse, physical condition, and signs of toxicity; monitor for suicidal ideation; administer medications; and provide support during withdrawal.

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

What is the definition of dependence?

need for a substance to avoid withdrawal symptoms

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.

A client is admitted to the emergency room suffering from symptoms of alcohol withdrawal. What symptom of withdrawal is the priority to prevent?

seizures

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 consumed

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 nurse is teaching a group of smokers about the associated risks of tobacco use. The nurse explains that these clients are how many times more likely to develop peripheral vascular disease than nonsmokers? Fill in the blank with a number.

10 Explanation: Smokers are 10 times more likely to develop peripheral vascular disease than nonsmokers.

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?

2 weeks

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 patient who suffers from alcoholism is prescribed disulfiram and wants to know how it works. How would the nurse explain that this medication assists the patient in refraining from ingestion of alcohol?

Allows the accumulation of acetaldehyde

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 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

Within 8 hours of her last drink, a client with alcoholism experiences tremors, loss of appetite, and disordered thinking. The nurse believes this client is in withdrawal. What should the nurse do next?

Obtain a physician's order for lorazepam (Ativan)

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

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

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

A 51-year-old male has been admitted to the detoxification unit with acute symptoms of alcohol withdrawal. Nursing assessment is likely to reveal what?

Tremors, headache, flushed face, and hallucinations

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

A client is being seen in clinic for a drug abuse problem. Signs and symptoms include burns on the face and fingertips, a chronic cough, and pulmonary congestion. The physician suspects the client is addicted to:

cocaine