Nursing Psych Prep-U Practice Ch. 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 - increased TSH - iron deficiency
decreased thiamine level
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? "How much alcohol do you consume?" "How many siblings do you have?" "Did your parents consume alcohol when you were growing up?" "Which substances do you routinely use?"
"Did your parents consume alcohol when you were growing up?"
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? "Do you consider yourself to be an alcoholic?" "Have you ever felt like you should cut down on your drinking?" "How many drinks do you have in a typical week?" "Have you ever required medical treatment for an illness related to alcohol use?"
"Have you ever felt like you should cut down on your drinking?"
A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse? - I can still hang out with my old friends. I am just not going to use. - I'm not very comfortable with being alone yet - I'm going to start up a new hobby playing basketball - When I think I'm going to use I'm going to run around the block.
"I can still hang out with my old friends. I am just not going to use."
A client with alcohol use disorder is admitted for treatment. Which statement indicates that the nurse has an issue with the client's condition? "Tell me how you are feeling right now." "I have family members with the same problem." "Explain to me when you started using alcohol." "So you attended Alcoholics Anonymous meetings for how long?"
"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 will take a dose of the medication when I get a craving for the drug. - I'm going to get a new hobby and try something new - I plan to attend the group meetings - I'm going to only take the pain meds when I severely need it
"I plan to attend the group meetings."
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? "You want to make your family proud so include them in your road to sobriety." "Let's look at this in the short term and determine what you can do to stay sober today." "Unfortunately, it is very realistic for you to think in those terms since it is possible to relapse." "You can do it. You will have to work very hard to maintain your sobriety but others have done it."
"Let's look at this in the short term and determine what you can do to stay sober today."
The nurse is talking with a client regarding their addiction to opioids. The client states, "I am unhappy in my job. My spouse is always nagging at me to make more money. The kids want more expensive toys." Which is the most therapeutic response by the nurse? "It sounds as though your spouse and children really want a lot from you." Correct response: "Let's talk about your behaviors and how you are responsible for your addiction."
"Let's talk about your behaviors and how you are responsible for your addiction."
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 and heroin actually have a very similar potential for addiction." "Most people are unaware of the fact that marijuana is actually a very addictive drug." "Heavy marijuana use has resulted in severe withdrawal symptoms in some people once they decide to quit." "Marijuana use can result in psychological dependence, which can have a very negative effect on your life."
"Marijuana use can result in psychological dependence, which can have a very negative effect on your life."
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? "Most people are unaware of the fact that marijuana is actually a very addictive drug." "Marijuana use can result in psychological dependence, which can have a very negative effect on your life." "Heavy marijuana use has resulted in severe withdrawal symptoms in some people once they decide to quit." "Marijuana and heroin actually have a very similar potential for addiction."
"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? "We can meet whenever we need to, but it really is inconvienent!" "This has been a difficult situation for all of us and disturbing to the entire family." "My sibling would not drink as much if their spouse was more understanding." "My sibling is so proud and happy to be able to attend the kids' ball games."
"My sibling would not drink as much if their spouse was more understanding."
The nurse is talking with the spouse of a client admitted for substance use disorder and overdose. Which statement(s) made by the spouse indicates that they are exhibiting enabling behaviors? Select all that apply: - "I can't keep money in the house and have to lock up jewelry in a safe." - "I am so scared about my spouse getting fired; I often call in sick so they won't." - "If I don't give them money for the drugs, they will just steal it anyway." - "My spouse had a terrible childhood and I would probably do the same things." - "I told my spouse that in order to be able to come home, they will first have to go to rehab."
- "I am so scared about my spouse getting fired; I often call in sick so they won't." - "If I don't give them money for the drugs, they will just steal it anyway." - "My spouse had a terrible childhood and I would probably do the same things."
A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which of the following statements would indicate that teaching has been effective? - Drinking alcohol while taking Antabuse can cause dangerous symptoms." - "Antabuse will block my cravings for alcohol so I'll have less desire to drink." - I need to worry about low vitamin B1
- Drinking alcohol while taking Antabuse can cause dangerous symptoms."
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 - impaired judgement - amazing coordination - altered mood - difficulty coordinating movements
- difficulty coordinating movements
The nurse is talking with a client regarding their addiction to opioids. The client states, "I am unhappy in my job. My spouse is always nagging at me to make more money. The kids want more expensive toys." Which is the most therapeutic response by the nurse? - sounds like your spouse and children require a lot from you - you need to get over it and find a new job - you seem to be really unhappy in life - lets talk about your behaviors and how you are responsible for your addiction
- lets talk about your behaviors and how you are responsible for your addiction
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. "I can take this medication once a day." "It may produce the euphoria of alcohol." "Using this drug will reduce the appeal of alcohol." "Taking this will improve my appetite and nutritional status." "This med causes itching if alcohol is consumed."
- using this drug will reduce the appeal of alcohol - I can take this medication once a day
Disulfiram should not be administered until a client has abstained from alcohol for at least how long?
12 hours
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? 48 hours 24 hours 18 hours 12 hours
12 hours
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 - 4 pm - 12 am - 8 pm
4 am
Which client is exhibiting the effects of alcohol tolerance? A 22-year-old who now drinks nine or ten drinks in order to get the same effect that the client used to get from drinking a six pack A 66-year-old who has been admitted to the emergency department with apparent delirium tremens A 28-year-old who is experiencing the signs and symptoms of alcohol withdrawal A 59-year-old whose recent CT scan reveals the presence of Wernicke's encephalopathy
A 22-year-old who now drinks nine or ten drinks in order to get the same effect that the client used to get from drinking a six pack
uspicion 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 Frequently calling off work for undefined illnesses Asking to be scheduled for weekend shifts as much as possible Spending a considerable amount of shift time off the unit
Having several clients complain that their pain medication is not working
A client is educated about taking disulfiram at home to help with abstaining from alcohol. Which statement made by the client indicates the education provided is effective? - by taking this med it will prevent the cravings for alcohol - I need to read product labels carefully to avoid all products containing alcohol - I can have a drink every week - I need to take this on an empty stomach
I need to read product labels carefully to avoid all products containing alcohol
Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply. It is not an opiate. It is a legal medication. It is controlled by a health care provider. It is available in tablet form.
It is a legal medication. It is controlled by a health care provider. It is available in tablet form.
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. - test for dementia - monitor for cirrhosis from long-term effects of alcohol use. - low blood pressure and potential A-fib on the monitors
Monitor for Korsakoff syndrome from long-term effects of alcohol use.
A client is readmitted to the detox unit for the fourth time in 3 years. The nurse states in the morning report, "Not again! Why should we keep trying to help them? They obviously don't want it." Which statement is reflective of the nurse? - The nurse lacks the self-awareness to work effectively with this addicted client. - The nurse is expressing her concern and advocating for the patient. - The nurse understands that the patient cannot be helped. - The nurse is displaying prejudice and believes that she is too good to help this patient.
The nurse lacks the self-awareness to work effectively with this addicted client.
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 Suggests the client may pass out and have episodes of memory lapse The client is minimizing the consumption of alcohol and is in denial Determines the client may drink frequently but does not have a problem
This is an indication of long-term use of alcohol for this client
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? - Wernicke-Korsakoff syndrome - Alcohol withdrawal syndrome - Continuing intoxication - Delirium tremens
alcohol withdrawal syndrome
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. Monitor condition with frequent vital signs. Focus on cognition and ability to arouse. Inquire as to what opioid was taken.
administer naloxone
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 - elders - middle aged - young adults
adolescents
Which of the following substances is abused most often in the United States? - alcohol - weed - nicotine - meth
alcohol
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? - intoxication - alcohol withdrawal syndrome - paranoia - atrial fib.
alcohol withdrawal syndrome
A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, sweaty and has some gastrointestinal (GI) symptoms. Which issue do these symptoms correlate with? - wernicke-korsakoff syndrome - alcohol withdrawal syndrome - toxic shock - continued intoxication
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 of the conditions attribute to the alcohol abuse - gastritis and esophagitis - liver enzymes and gastritis - pancreatitis, liver enzymes, cardiomyopathy, and esophagitis
all conditions attribute to alcohol abuse
A client is being treated on the inpatient unit for alcoholism. Disulfiram (Antabuse) has been prescribed for a client receiving treatment for alcoholism. Which of the following should be included in the client's plan of care? - Avoid all products containing alcohol - Limit alcohol consumption to a moderate level - Have weekly blood alcohol levels drawn - Do not drive heavy machinery
avoid all products containing alcohol
Safe alcohol withdrawal usually is accomplished with the administration of which medication classification? -Anticonvulsants -Antipsychotics -Antidepressants -Benzodiazepines
benzodiazepines
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? - antidepressants - anticoagulants - benzodiazepines - antipsychotics - mood stabilizers
benzodiazepines
The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take? -Call the manager and report the observations. -Ask other nurses if they have noticed anything unusual. -Tell the nurse, "I know you've been stealing diazepam." -Observe the nurse as injections are prepared and administered.
call the manager and report the observations
The nurse is caring for a client who is prescribed disulfiram prior to being discharged from an inpatient treatment facility. Which teaching statement will the nurse prioritize? - take with food - check ingredients of all the beauty products you use - avoid calcium based products - it will allow the patient to feel energized
check beauty products that contain alcohol
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder? - client binge drinks a few times a week rather than daily - client had 6 drinks a few hours ago -the client had a drink a few hours ago - the client drinks monthly
client had 6 drinks a few hours ago
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? - meth - marijuana - nicotine - cocaine
cocaine
A client is diagnosed with Korsakoff amnesic syndrome. Which of the following would the nurse most likely assess? Select all that apply. Diaphoresis - sweating Attention deficit Hypertension Confabulation - conversation Vision impairment
confabulation - shows memory loss attention deficit vision impairment
The nurse is assessing a client who uses alcohol daily. On which reason(s) would the nurse focus the assessment when the client denies a family history of alcohol use? Select all that apply. cope with life relieve stress and tension increase feelings of power decrease psychological pain decrease muscle tension
cope with life relieve stress and tension decrease psychological pain increase feelings of power
he nurse is caring for a client with delirium tremens (DTs). Which development constitutes a medical emergency? atrial fibrillation on the monitor jaundice and irritability development of seizure activity urine has a coffee appearance
development of seizure activity EXPLAIN: alcohol-induced delirium tremens (DTs) is a life-threatening situation and must be considered a medical emergency.
A client with a history of alcohol use seeks medical attention for a new onset of flushing, throbbing headache, and nausea and vomiting. Which question would the nurse ask to determine the reason for the client's symptoms? - when did you last ingest alcohol - did you drink while taking disulfiram - what substances are you taking
did you drink while taking disulfiram
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
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? - Mood changes -Giddiness - Difficulty coordinating movements - Impaired judgment
difficulty coordinating movements
A client with a history of opioid use disorder is exhibiting manifestations of moderate withdrawal. Which assessment finding(s) will the nurse document as evidence of moderate withdrawal? Select all that apply. - rhinorrhea - lacrimation - muscle aches - dilated pupils - dysphoria
dilated pupils and muscle aches
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? psychomotor hypoactivity and hypotension flushed face, headache, and tremors bradycardia and generalized seizures anhidrosis, hypotonicity, and delusions
flushed face, headache, and tremors
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. Remind them that substance dependency is a disease, not a mental disorder. Ask them to make a list of all the people they harmed during their addictions. Suggest that they try to confront other issues in their lives, such as estranged relationships or financial issues.
help them to identify appropriate diversional activities
The charge nurse observes another nurse reporting for work looking unkempt and disheveled with uncoordinated movements and breath smelling of alcohol. Which is the priority action by the charge nurse? Talk to other employees on the unit to see if anyone else is notices the behavior. Tell the nurse that they are suspected of being intoxicated and to go home. Give the nurse information about the hospital's employee assistance program. Immediately call the supervisor to report the nurses' behavior.
immediately call supervisor and report the behavior
The nurse is caring for a client with a history of a substance use disorder. Which problem(s) will the nurse add to the plan of care when the client reports difficulty adjusting without the substance? Select all that apply. -fear of developing physical symptoms -ineffective rehabilitation -inability to fulfill role expectations -ineffective coping -difficulty with communication
inability to fulfill role expectations, ineffective coping
Disulfiram has which of the following effects on prothrombin time? Increase No effect Remains within normal limits Decrease
increase
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 Indicates that the client does not experience tolerance and withdrawal symptoms Indicates that the client experiences tolerance and withdrawal symptoms Indicates that the client has a medical reason for taking the substance
is an umbrella term for substance abuse and substance dependence
When discussing methadone treatment with a client, the nurse should include what? -It is a nonaddictive treatment. -The cure rate is extremely high. -It takes 1 to 2 years to cure an opiate addict. -It decreases the severity of heroin withdrawal symptoms.
it decreases the severity of heroin w/drawl symptoms
Which characteristic of the 12-step program distinguishes it from other programs? - its a self help group that focuses on total abstinence - the philosophy that it is possible to reduce the use of substances without abstaining - those who show up end up being successful
it is a self-help group that focuses on total abstinence
what medication is used to prevent alcohol withdrawal symptoms? - lorazepam (Ativan) - hydroxyzine - SSRI - SSNI
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. Heart rate around 72 beats/min Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors Increased appetite
marked diaphoresis auditory hallucinations gross uncontrollable tremors
A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client? -Pad the side rails of the bed because seizures are likely. -Check the client's belongings for additional drugs. -Prepare a dose of ipecac, an emetic. -Monitor respiratory function.
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 - thiamine - magnesium - sucrose
naloxone
The public health nurse is planning community education on substance use. Which will the nurse prioritize? - assessment - treatment - prevention - recovery
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? -ignore the nurse colleague's behavior until others notice as well -talk to other staff members to see if they have noticed anything -report the nurse colleague's behavior to the supervisor on the floor -privately confront the nurse by asking what is going on with them
report the colleagues behavior to the supervisor on the floor
The nurse is caring for a client with a substance use disorder. Which action(s) would the nurse include when teaching the family on ways to support the client? Select all that apply. -Apply ways to decrease codependency between family members. -Focus on future plans. -Promote coping skills. -Practice different situations with role-play. -Set realistic goals.
set real goals promote coping skills practice different situations w/ role play apply ways to decrease codependency between family members
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? - I don't know why you keep coming - you need to commit to the program - sometimes it takes a few times before relapses stop occurring
sometimes it takes a few times before relapses stop occurring
The nurse is caring for a group of clients. Which client does the nurse recognize as being most at risk for developing a substance use disorder? - child with sensory issues - teenager client with a mood disorder - adult who just lost their job
teen with a mood disorder
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder? -The client engages in binge drinking a few times a week rather than -drinking consistently each day. -The client had six drinks a few hours ago. -The client uses marijuana in addition to alcohol. -The client has a demonstrated family history of alcoholism.
the client had 6 drinks a few hours ago
The nurse is gathering data on a client who drinks vodka every day, gradually increasing over the past 2 to 3 years. The client maintains a job, home, and marriage. How will the nurse document the assessment data? The client admits alcohol use and is acutely intoxicated. The client has developed a tolerance. Screening for other substances is warranted. The client is abusing substances.
the client has developed a tolerance
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 displaying narcissistic behavior. -The spouse is acting in a codependent manner. -The spouse is at fault for the client's addiction. -The spouse is intentionally sabotaging the client's recovery.
the spouse is acting in a codependent manner
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? -"I will encourage my spouse to go to meetings." -"They only drink after work." -"I know it's a problem." -"My partner needs to stop going to the club."
they only drink after work
Which medication is used to prevent Wernicke-Korsakoff syndrome? -Thiamine (vitamin B1) -Lorazepam -Cyanocabalamin -Folic acid (folate)
thiamine (Vit B1)
A client with chronic alcoholism has been found to have Wernicke encephalopathy. This irreversible complication is characterized by what? Hypothalamic and mammillary body lesions Thiamine, or vitamin B1, deficiency Double vision and rapid eye movement Inability to learn new skills and short-term memory loss
thiamine, or vit B1, deficiency
A client with chronic alcoholism has been found to have Wernicke encephalopathy. This irreversible complication is characterized by what? Hypothalamic and mammillary body lesions Double vision and rapid eye movement Inability to learn new skills and short-term memory loss Thiamine, or vitamin B1, deficiency
thiamine, or vit b1 deficiency
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? - "Include the client in family outings even when the client is drinking." - "Search the house regularly for alcohol." - "Try to maintain a normal home environment for yourself and the children." - "Help the client avoid embarrassment by supporting the client when the client makes excuses for failing to meet obligations."
try to maintain a normal home environment for yourself and the children
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? -Scurvy -Alcoholic dementia -Wernicke-Korsakoff syndrome -Alcohol dependence with memory impairment
wernicke-korsakoff syndrome