PCC IV Unit 3 Addiction
To prevent Wernicke's encephalopathy from heavy alcohol use, the nurse anticipates an order for which medications? a. Benzodiazepine b. Thiamine and B complex c. Vitamins C and D3 d. Klonopin
ANS: B The B vitamins will prevent or reverse Wernicke's if given early enough. Benzodiazepines are often used to prevent and treat DTs and to decrease respiratory depression and hypertension. Vitamins C and D3 are not related to alcohol withdrawal
The nurse is completing a health history with a 16-year-old client and determines the client would benefit from teaching about substance abuse. Which client statement(s) caused the nurse to come to this conclusion? Select all that apply. A) "I drink alcohol with my friends on the weekends." B) "I smoke cigarettes on a daily basis." C) "I use my seat belt every time I ride in a car." D) "I became sexually active at the age of 13." E) "I get all A's and B's in school."
Answer: A, B, D Explanation: Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse. Getting good grades and wearing a seat belt are not risk factors for substance abuse.
The nurse is giving a health promotion class to adolescents. Which point is most important to convey to this audience? A) Teens are not strongly influenced by tobacco advertising. B) Smoking causes lung cancer. C) Cost is no deterrent to smoking. D) Alcohol use is strongly associated with smoking.
Answer: B Explanation: Although alcohol abuse, a sedentary lifestyle, and drug abuse are preventable causes of mortality in the United States, smoking is now the number one cause of preventable death and disease for both men and women.
During history-taking, a patient tells the nurse that he is addicted to alprazolam and that he takes six 1 mg tablets a day. He quit cold turkey yesterday and now presents with extreme agitation, increased heart rate, and panic. The nurse suspects which disorder? a. Stress reaction b. Delerium tremens c. Overdose d. Relapse
ANS: A Stress reaction is a withdrawal symptom that can occur when detoxing too quickly. DTs are usually associated with alcohol withdrawal. Overdose of alprazolam would present with extreme drowsiness, confusion, muscle weakness, and loss of balance or coordination. The effects of alprazolam are dizziness, drowsiness, dry mouth, and lightheadedness.
The nurse recognizes a potential health threat to an alcoholic patient who is using the drug disulfiram when the nurse reads in the health record that the patient is also taking which of the following? (Select all that apply.) a. Blood thinners b. Diphenhydramine c. Alcohol d. Penicillin e. Mouthwash
ANS: A, C, E Disulfiram increases the effect of anticoagulants such as warfarin (Coumadin). Ingesting alcohol may cause headache, nausea, vomiting, tachycardia, chest pain, or dizziness. Mouthwash can have alcohol as one of the main ingredients and should be checked prior to using.
A patient who was admitted 24 hours ago has become increasingly irritable and now says there are bugs on his bed. Which condition should the nurse suspect? a. Alcohol-induced psychosis b. Delirium tremens (DTs) c. Neurologic injury related to a fall d. Posttraumatic stress reaction
ANS: B During the 6 to 96 hours after last alcohol use, patients may experience DTs, as evidenced by disorientation, nightmares, abdominal pain, nausea, and diaphoresis, as well as elevated temperature, pulse rate, and blood pressure measurement and visual and auditory hallucinations.
Strategies that a nurse could use in a motivational interview to increase the chances of change include which of the following? (Select all that apply.) a. Educating the patient on the physical damage the substance is causing b. Encouraging the patient to think of ways to change environmental triggers to abuse substances c. Asking the patient how they think substance abuse affects their family life d. Explaining to the patient that substance abuse affects everyone in the family and give examples e. Asking the patient what methods they think would work and encouraging participating in self-help groups
ANS: B, C, E Empowering the patient by helping them see what effect the abuse has on their life is a key component of motivation. Educating the patient is too much like lecturing and may cause resistance. Explaining how the family responds to the problem may elicit guilt and resistance.
The nurse is caring for a patient who is experiencing alcohol withdrawal. What is the highest priority for this patient? a. Describe how the alcohol is causing the withdrawal effects. b. Leave the patient by him/herself so as not to cause agitation. c. Promote a safe, calm, and comfortable environment. d. Refer the patient to an alcohol-abuse counselor.
ANS: C The main priority is the patient's safety due to risk of harm from seizures, DTs, and anxiety. The nurse could provide referrals or discuss the relationship of alcohol to physical problems after the withdrawal period is over. Do not leave the patient alone, as many patients will need reassurance that they will survive the ordeal of withdrawal.
The nurse is assessing a patient using the CAGE Questionnaire. The patient answers yes to all of the questions. The nurse suspects alcoholism and feels the patient is in denial when the patient makes which statement? a. I go to meetings once a day and still drink. b. My family and friends have been avoiding me lately. c. I don't have a problem with alcohol. I can quit anytime I want to. d. I know it will be hard to quit, but I am willing to try.
ANS: C The patient may need help admitting that there is a problem. The CAGE is designed to objectively assist in assessing problems related to alcohol use. A patient who states they are going to meetings is admitting they have a problem even if they still drink. Admitting that quitting is difficult is acceptance that there is a problem. Reality is setting in for a patient who can see that family and friends are avoiding them.
The nurse assesses the outcomes of a motivational interview on a patient with a dual diagnosis of alcoholism with delirium tremens (DTs) and determines that the communication was nontherapeutic. What is the nurse's next priority? a. Encourage the patient to think of ways to change environmental triggers to abuse substances. b. Ask the patient what methods they think would work and encourage participating in self-help groups. c. Notify provider to obtain order for oxazepam and vitamin B infusion. d. Notify provider to obtain order for CT scan and psychologic consult.
ANS: C The patient will need to be treated for the psychosis prior to conducting the motivational interview, because the patient can become violent and nonreceptive to the interventions. Oxazepam and vitamin B are the two therapies that work for DTs.
A 45-year-old man is brought to the emergency department presenting with a respiratory rate of 6 breaths/min, and cardiac dysrhythmias. What is the most appropriate question the nurse should ask the patient's friend? a. Does he take amphetamines or uppers? b. Has he ever used LSD? c. Have you two been out of the country in the last 2 days? d. Is he using any opioids such as heroin?
ANS: D The clinical manifestations of an opioid overdose include seizures, shock, respiratory depression, dysrhythmias, and altered level of consciousness. An opioid overdose is a medical emergency. Amphetamine overdose is ruled out because it causes hypertension and central nervous system disturbances such as paranoia, panic, and delusions. LSD overdose would also manifest with hypertension and tachypnea along with hallucinations and possible loss of contact with reality. Travel outside the country is unrelated.
A college student attends a seminar on alcohol abuse. Which statement would alert the nurse that the student needs more education? A) "The children of alcoholics are less likely to become alcoholics." B) "Native Americans are more likely to become alcoholics." C) "Married college graduates are less likely to become alcoholics." D) "Childless people are more likely to become alcoholics than parents."
Answer: A Explanation: A genetic predisposition to alcoholism is established for Native Americans and the children of alcoholics. Married people, college graduates, and parents are less likely to become alcoholics.
The nurse is caring for a client who has been diagnosed with a cocaine addiction. For which additional disorder should the nurse assess this client? A) Anxiety B) Diabetes C) Weight gain D) Kidney stones
Answer: A Explanation: Anxiety and depressive disorders frequently occur with substance abuse. More than 90% of individuals who commit suicide have a depressive or substance abuse disorder. Weight gain, diabetes, and kidney stones are not linked to substance abuse.
The client with a history of alcohol abuse is being discharged. Which intervention is the discharge priority of choice for the multidisciplinary care team in collaboration with the client? A) Disulfiram B) AA C) Contingency contract D) Varenicline
Answer: A Explanation: Disulfiram (Antabuse) causes the client to become immediately and violently ill when consuming alcohol. AA (Alcoholics Anonymous) and a contingency contract are appropriate tools but are not as urgent as Disulfiram. Varenicline is a drug for smoking cessation.
A nurse is concerned about potential substance abuse by a coworker. Which of the coworker's behaviors would place the clients on the unit at risk for injury? A) The nurse in question frequently volunteers to give medications to clients. B) The nurse in question prefers not to be the "medication nurse" on the shift. C) The nurse in question declines to take scheduled breaks. D) The nurse in question frequently requests the largest client care assignment for the shift.
Answer: A Explanation: Frequently volunteering to give medications or having excessive medication wasting could be a sign that a nurse is using or diverting drugs. The nurse who is unable or unwilling to manage a large client care assignment or who requests to administer medications could be a substance abuser. Taking frequent or lengthy breaks might signal substance abuse.
The nurse provides a wellness program to a group of pregnant adolescents at risk for substance abuse. Which participant statement indicates that teaching has been effective? A) "Drinking alcohol and smoking marijuana can harm my baby." B) "I need to take good care of myself by participating in vigorous exercise." C) "My anemia and eating mostly fast food are not important." D) "I should seek prenatal care at some point in the pregnancy."
Answer: A Explanation: Pregnant adolescents are at great risk for complications such as pregnancy-induced hypertension, anemia, preterm birth, low-birth-weight infants, and fetal harm from cigarette smoking, alcohol consumption, or the use of street drugs. Early and regular prenatal care is the best intervention to prevent complications or to detect them early, to minimize the harm to both the teen and her fetus. Pregnant adolescents are at great risk for complications such as anemia. Vigorous exercise would not necessarily promote a healthy pregnancy and does not indicate an understanding of the increased risk for an adolescent who is at risk for substance abuse.
While practicing at an outpatient addiction clinic, the nurse is summarizing a diagram in the orientation handbook for a new associate she is precepting. Which statement most closely aligns with the meaning of this diagram? A) Addiction involves an alteration in the amount of available neurotransmitters. B) Actions at the neurotransmitter level affecting addiction are not genetic. C) High self-esteem as a basis for pleasure seeking lowers neurotransmitter levels. D) An addictive personality is identified by differences in the processing of neurotransmitters.
Answer: A Explanation: Substances of addiction alter the amount of available neurotransmitters, including dopamine, serotonin, and norepinephrine. Several genes have been identified that seem to influence the risk for alcohol dependence. Low self-esteem increases the risk for addiction. No addictive personality type has been identified.
A client who is attending a Narcotics Anonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. Which answer is the best response by the nurse? A) To admit to having a problem B) To learn problem-solving skills C) To take a moral inventory of self D) To make amends to people they have hurt
Answer: A Explanation: The initial outcome for clients in substance abuse programs is to admit they have a problem with drugs or alcohol. Clients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. Learning problem-solving skills is a later outcome for a substance abuse program. Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.
A client with alcoholism is receiving court-ordered care in a residential treatment facility. After alcohol is discovered in the client's room, she denies that it belongs to her. Which statement(s) by the nurse will support the treatment plan made in collaboration with the physician and the addiction therapist? Select all that apply. A) "You will lose your day pass privileges for this Sunday." B) "We have a video of you accepting the alcohol from your brother." C) "What do you think about sharing this at AA tonight?" D) "You won't be allowed to go to dinner tonight." E) "You have violated our behavior contract."
Answer: A, B, C, E Explanation: Used with care and a calm attitude, confrontation interferes with the client's ability to use denial or rationalization. Losing privileges is a consequence of violating the behavior contract. Participation in AA will provide peer feedback. Withholding food is inappropriate, particularly for a client with potential nutritional deficits.
The nurse is collecting data on prenatal clients at a clinic on a Native American reservation in Arizona. One client has risk factors for substance abuse. What physical sign or signs did the nurse assess that suggest substance abuse in this client? Select all that apply. A) Dilated pupils B) Odor of alcohol on the breath C) Frequent accidents or falls D) Underweight E) Dressed in jeans and a t-shirt
Answer: A, B, D Explanation: Physical signs of substance abuse include dilated or constricted pupils, inflamed nasal mucosa, evidence of needle "track marks" or abscesses, poor nutritional status, slurred speech or staggering gait, and an odor of alcohol on the breath. Frequent accidents or falls are behavioral signs of substance abuse. Wearing a jeans and t-shirt is not indicative of substance abuse.
A nurse is caring for a client with congestive heart failure who currently smokes cigarettes and has a 50 pack-year smoking history. When providing smoking cessation education to the client, the nurse will include which statement(s) regarding the pathophysiology of nicotine use? Select all that apply. A) "In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine." B) "In high doses, nicotine stimulates the parasympathetic system to release epinephrine, causing vasoconstriction." C) "Initially, nicotine increases mental alertness and cognitive ability." D) "Nicotine is a nonpsychoactive substance found in tobacco." E) "Gradual reduction of nicotine appears to be the best method of cessation."
Answer: A, C Explanation: In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine and epinephrine, causing vasoconstriction. Initially, nicotine increases mental alertness and cognitive ability, but eventually it depresses those responses. Nicotine is a psychoactive substance found in tobacco.
The nurse has completed her assessment of a client with a history of alcoholism who is hospitalized with anorexia, dysphagia, odynophagia, and chest pressure after eating. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Imbalanced Nutrition: Less Than Body Requirements C) Disturbed Sensory Perception D) Disturbed Thought Processes
Answer: B Explanation: An alcoholic client with anorexia is at risk for Imbalanced Nutrition, Less Than Body Requirements. Ineffective Coping is a potential diagnosis used in substance abuse. Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.
During visitation on the unit, the nurse is observing the family dynamics of an adolescent client who has an addiction problem and recognizes that the family is experiencing behaviors consistent with codependence. Which problems might the nurse expect this family to manifest on an ongoing basis? A) Frustration intolerance B) Enabling C) Argumentative behaviors D) Impatience
Answer: B Explanation: Codependents often engage in enabling behavior, which is any action an individual takes that consciously or unconsciously facilitates substance dependence. Although impatience, frustration intolerance, and argumentative behaviors may be present in this family, they are generally not related to the cycle of codependence and addiction.
A male college student is incoherent after taking "downers with beer." For which health problem should the nurse observe in this client? A) Hallucinations B) Respiratory depression C) Seizure activity D) Signs of withdrawal
Answer: B Explanation: Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The client who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this client as respiratory depression.
A nurse manager in the ICU notes a pattern of a staff nurse excessively "wasting" narcotics, and the manager suspects the staff nurse may be impaired. Which clinical situation may have contributed to the staff nurse's problem? A) Caring for clients who require IV medications B) Easy access to prescription drugs C) Easy access to client care areas D) Caring for clients who require numerous oral medications
Answer: B Explanation: Easy access to prescription drugs presents an at-risk situation for nurses who abuse substances. The other situations are common for all nurses and do not necessary pose an increased risk for substance abuse.
At a neighborhood clinic, the nurse is planning addiction treatment groups. What knowledge of addictions and related therapies will facilitate implementation of the groups? A) Relapse is a common feature of substance abuse. B) Hereditary, as well as complex environmental influences, predisposes one to substance dependence. C) Clients with a substance dependence cannot be held accountable for their actions. D) Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are accepted treatment approaches.
Answer: B Explanation: Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.
The nurse is collecting data from a client regarding alcohol use history. What question will provide the greatest amount of information? A) Are you a heavy drinker? B) How many alcoholic beverages do you drink each day? C) Is alcohol use a concern for you? D) Drinking doesn't cause any problems for you, does it?
Answer: B Explanation: Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a "yes" or "no" will limit the information obtained.
A client is admitted for the fourth time in 4 years for alcohol detoxification. Which aspect(s) of the pathophysiology of alcoholism will impact the plan of care? A) Aging can impact the ability of the body to handle detoxification from alcohol and drugs. B) The withdrawal may be greater this time. C) The dependency might have been greater this time. D) Increased difficulty with alcohol detoxification is likely the result of an addiction to another substance at the same time.
Answer: B Explanation: Subsequent episodes of withdrawal tend to get progressively worse due to kindling. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications. Aging does not play a role in the process. There is no evidence to support the suspicion that the client is addicted to additional substances or has an increased degree of dependence.
The 70-year-old client with heart disease tells the nurse, "I am sick because I sinned by smoking cigarettes." What is the nurse's best response to this dying client? A) "Smoking cigarettes isn't a sin. There are many worse habits you could have." B) "Cigarette smoking was desirable when you began smoking. We didn't know about the problems it could cause." C) "Why don't we call the hospital chaplain and you can pray about your sins?" D) "You are correct, but it is too late to do anything about it now."
Answer: B Explanation: This client is in distress and is seeking forgiveness. The nurse should offer this forgiveness and a reason the forgiveness is valid. If the nurse tells the client that it is too late to do anything about the problem, there is a possibility that distress will increase. Suggesting that the hospital chaplain be called for prayer reinforces the idea that smoking cigarettes is a sin. Saying there are worse habits minimizes the client's concerns and does not offer forgiveness.
A nurse is caring for a client who is pregnant and requires IV antibiotic therapy for treatment of pyelonephritis. Prior to administering the medication, the nurse discovers the medication is Category B for pregnancy. This means which of the following? A) Controlled studies in women have demonstrated no associated fetal risk. B) There have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. C) Animal studies show teratogenic effects, but no controlled studies in women are available. D) Evidence of human fetal risk exists, but the benefits of the drug in certain situations are thought to outweigh the risks.
Answer: B Explanation: To provide information for caregivers and clients, the U.S. Food and Drug Administration (FDA) has developed a classification system for all medications administered during pregnancy. This system can be used to help determine the risk of prenatal substance exposure from use of legal medications whether they are abused or prescribed by a physician. In Category C, there have been no controlled studies in women in particular, but controlled human studies have failed to demonstrate a risk. The other choices are for additional classifications, not Category C.
A client who has smoked 2 packs of cigarettes per day for 34 years has a history of intermittent claudication, chronic bronchitis, and emphysema. After 6 weeks of cessation the client reports yelling at his spouse and "flying off the handle." Which effect or effects of cigarette smoking are associated with this scenario? Select all that apply. A) Nicotine causes destruction of the alveoli. B) The release of epinephrine causes vasoconstriction. C) Dopaminergic processes are implicated in withdrawal symptoms. D) Tar causes the mucus production seen in chronic bronchitis. E) Tobacco use causes atherosclerosis.
Answer: B, C, D, E Explanation: Nicotine causes the release of epinephrine, which triggers vasoconstriction, exacerbating intermittent claudication. Tobacco use causes atherosclerosis, which is seen in intermittent claudication. Tar and other chemicals, not nicotine, cause the destruction of the alveoli seen in emphysema and the productive cough seen in chronic bronchitis.
A new nurse orienting to the unit is preparing to assist with obtaining data for a screening tool to determine whether a client is addicted to alcohol. Which tool or tools will be used to assess the client? Select all that apply. A) OOWS B) MAST C) CAGE questionnaire D) B-DAST E) CIWA-ar
Answer: B, C, E Explanation: The CAGE questionnaire, MAST (Michigan Alcohol Screening Test), and CIWA-ar (Clinical Institute Withdrawal Assessment of Alcohol Revised) are all used to assess for alcohol-related problems. The B-DAST (Brief Drug Abuse Screening Test) is used to assess for addiction to substances other than alcohol. The OOWS (Objective Opiate Withdrawal Scale) is useful for assessing clients who are experiencing opiate withdrawal.
A nursing instructor is teaching her students about the comprehensive theory of addiction by George Engel. Which statement or statements indicate that the student understands the theory? Select all that apply. A) "Addiction occurs due to a lack of emotional attachment." B) "There is a biological factor involved in the development of addiction." C) "There are social factors that contribute to the development of addiction." D) "There is a moral factor involved in the development of addiction." E) "There is a psychological factor involved in the development of addiction."
Answer: B, C, E Explanation: The biopsychosocial explanation of addiction is supported by current research and takes a more holistic view of the problem. The biopsychosocial explanation links biological, psychological, and social factors as contributing to the development of addiction. The view of addiction as a moral disease is nontherapeutic. Viewing addiction as only a behavioral or emotional problem oversimplifies a complex issue.
A client is admitted to the Emergency Department after snorting phencyclidine piperidine (PCP). The healthcare provider has determined that the client overdosed on the drug. What action(s) does the nurse anticipate will be done to care for this client? Select all that apply. A) Obtain materials to assist with lavage. B) Initiate an IV. C) Initiate seizure precautions. D) Induce vomiting. E) Administer ammonium chloride.
Answer: B, C, E Explanation: The client has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or "speed" reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The client will require an IV line. The client will need to have seizure precautions such as padded side rails initiated. The client may also be given ammonium chloride to acidify the urine to help excrete the drug. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose.
The nurse is planning an inservice for the multidisciplinary team on smoking cessation care. Which statements should be included in the class? Select all that apply. A) There is no adverse risk if the client chooses to smoke while wearing a nicotine patch. B) Bupropion (Zyban) is used to suppress the craving for tobacco. C) A piece of nicotine gum should be chewed for 5 minutes of every waking hour then held in the cheek. D) Most persons quit smoking several times before they are successful. E) Alternative therapies should be considered to help reduce the stress that accompanies smoking cessation.
Answer: B, D, E Explanation: When teaching clients about smoking cessation, the nurse should emphasize that most persons who quit smoking try to quit several times before they are successful. Bupropion is used to suppress the craving for tobacco and is a viable option for this client. The proper use of nicotine gum is to take one piece when the urge to smoke occurs, up to 9 to 12 times daily. The gum should be chewed several times to soften it and then held in the buccal space for at least 30 minutes to absorb the medication. A client wearing a nicotine patch must not smoke because of increased risk for cardiovascular problems, including myocardial infarction. The nurse should always consider alternative therapies in addition to traditional therapies, as they may help the client deal with the stress that accompanies smoking cessation.
A nurse working at a clinic in a community serving a high population of smokers is planning an educational session on "Tips to Quit." Which topic will be appropriate for the session? A) Tell this group that smoking is unacceptable. B) Make sure the group is aware of the increased risk of liver disease and cancer of the esophagus. C) Review the available pharmacologic adjuncts to cessation. D) Recommend hypnosis at a local dinner theater.
Answer: C Explanation: Available pharmacologic adjuncts for smoking cessation should be discussed in a "Tips to Quit" community talk. Simply telling the group that smoking is unacceptable is not effective in promoting wellness. Discussing esophageal cancer and liver disease is inappropriate for a single educational session; lung cancer and cardiovascular disease are the primary health threats that should be discussed.
A nurse is caring for a client who displays addiction behavior toward the use of alcohol. The client reveals to the nurse that the client has been jailed twice for driving under the influence. The nurse understands that this type of behavioral therapy is which of the following? A) Positive reinforcement B) Negative reinforcement C) Positive punishment D) Negative punishment
Answer: C Explanation: Consequences that lead to a decrease in undesirable behavior are referred to as punishment. Positive punishment is the addition of a negative consequence if the undesirable behavior occurs; for example, the addict who drives under the influence is jailed or fined. Negative punishment is the removal of a positive reward if the undesirable behavior occurs; for example, the addict who does not show up for work loses his job. Consequences that lead to an increase in a particular behavior are referred to as reinforcement. Positive reinforcement provides a reward for the desired behavior, such as the pleasant sensation, or high, that comes from the use of a substance. Negative reinforcement removes a negative stimulus to increase the chances that the desired behavior will occur. An example of negative reinforcement is when the family of an addict refuses to support the behavior that results from use of the substance.
A 19-year-old pregnant client tells the nurse that she and her husband are going to a 50th wedding anniversary party for her grandparents this weekend. The client asks the nurse if it will be okay to have a few glasses of wine at the party. Which should the nurse reply? A) "Drinking a few glasses of wine will not be a problem." B) "Alcohol during pregnancy can cause the baby to be born without limbs." C) "Drinking any alcoholic beverages during pregnancy puts your baby at risk for injury." D) "Wine is acceptable but not hard liquor."
Answer: C Explanation: Drinking any alcohol, no matter what type and what quantity, during pregnancy increases the risk for accidents and damage to the infant. Mothers are encouraged to drink no alcohol at all during pregnancy. Wine can put the mother and fetus at risk as much as hard liquor.
A client with admitted use of cocaine during pregnancy has just experienced abruptio placentae. The father of the baby asks the nurse why this has happened to them. What risk factor for this health problem should the nurse explain to the father? A) Maternal smoking B) Genetic history C) Maternal cocaine use D) The mother having low levels of folic acid
Answer: C Explanation: Maternal cocaine consumption during pregnancy puts the woman at risk for abruptio placentae. Cocaine use is also associated with preterm birth, low birth weight, neonatal irritability, neonatal depression, SIDS, and developmental delays. Teratogens are medications known to adversely affect normal cellular development in the embryo or fetus. Folic acid is necessary for normal neural tube development. Genetic history does not affect the risk for spontaneous abortion.
A family member of a woman addicted to alcohol and opioids says, "I don't understand the reason for Naltrexone treatment for my daughter. Won't she just get high off of that?" What is the best explanation for this family member? A) "Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs." B) "Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer." C) "Naltrexone diminishes the cravings your daughter will feel for alcohol and opioids." D) "Naltrexone will prevent your daughter from getting drunk when she drinks."
Answer: C Explanation: Naltrexone diminishes the cravings for alcohol and opioids. Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed.
A nurse is caring for a client who smokes cigarettes and asks the nurse about nicotine replacement therapy (NRT). Which statement made by the nurse is appropriate? A) "Over-the-counter (OTC) NRTs include transdermal patches, gums, nicotine inhalers, and nasal sprays." B) "NRT helps to relieve the psychological and physiological effects of nicotine withdrawal." C) "NRT does not address addictive behavior." D) "Combining the use of NRT and a smoking cessation program is no more effective than NRT use alone."
Answer: C Explanation: Nicotine replacement therapy (NRT) does not address addictive behavior. NRT helps to relieve some physiological, not psychological, effects of nicotine withdrawal. Over-the-counter (OTC) NRTs include transdermal patches and gums. Nicotine inhalers and nasal sprays are available by prescription only. Combining the use of NRT and a smoking cessation program is more effective than the use of NRT alone.
After an assessment of a new client, a nursing student expresses a belief that drug addiction is not a real illness, as these clients "did it to themselves." What should the staff nurse respond to this student's comment? A) "Sometimes a client doesn't show much effort." B) "We are legally obligated to provide care." C) "It is important to remain nonjudgmental when caring for any client, even a drug addict." D) "You are right. I don't know why we bother."
Answer: C Explanation: Nurses must provide a nonjudgmental attitude with their clients in order to promote trust and respect. Even if a client is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. Although it is true that nurses are legally obligated to provide care, this response is not client-focused and is therefore inappropriate.
A client has been admitted with chronic obstructive pulmonary disease (COPD) and has asked the nurse for help and information regarding nicotine addiction and ways to quit smoking. The nurse will evaluate the treatment and determine that a goal has been met when the client states: A) "I will keep a pack of cigarettes in my closet in case I need it." B) "I will taper off smoking gradually." C) "I will chew sugar-free gum when I want a cigarette." D) "I will eat a snack when I am feeling nervous."
Answer: C Explanation: One goal for clients who are attempting to deal with addiction is stating adaptive coping mechanisms to use when stressed. The goal has been met when the client expresses the intention to use a healthy coping mechanism-such as chewing sugar-free gum-when the urge to smoke arises. Tapering off smoking and keeping cigarettes close by are examples of the client who is not wholly committed. Eating when stressed may lead the client to substitute eating for smoking, which is a form of denial.
A pregnant woman admits to intravenous drug use. She had a negative HIV screening test just after missing her first menstrual period. For which manifestation should the nurse suspect the client needs to be retested for HIV? A) Hemoglobin of 11 g/dL and a rapid weight gain B) Elevated blood pressure and ankle edema C) Unusual fatigue and oral thrush D) Shortness of breath and frequent urination
Answer: C Explanation: The client who is HIV-positive would have a suppressed immune system and would experience symptoms of fatigue and opportunistic infections such as oral thrush. The client with HIV would be anemic and anorexic. The client would have a decrease in blood pressure, and no ankle edema. Shortness of breath and frequent urination do not indicate a need to retest for HIV.
A nurse is caring for a newborn who is being treated in the NICU due to complications from exposure to illicit drugs while in the womb. The newborn has microcephaly and multiple cerebral infarcts and is inconsolable with a high-pitched cry. Which illicit drug is likely to blame for the newborn's symptoms? A) Marijuana B) PCP C) Cocaine D) LSD
Answer: C Explanation: The newborn is likely showing symptoms of cocaine withdrawal. Although the other choices have been linked to fetal manifestations, they do not match the clinical manifestations that the newborn is displaying.
A nurse caring for a pregnant client intoxicated with cocaine will notice which clinical manifestations? Select all that apply. A) Increased appetite B) Pinpoint pupils C) Muscle jerks D) Hypertension E) Bradycardia
Answer: C, D Explanation: Acute cocaine intoxication manifests as muscle jerking, hypertension, decreased appetite, dilated pupils, and tachycardia.
A nurse working in the Emergency Department is caring for a client who has overdosed on cocaine. The nurse receives an order from the client's physician to administer an antipsychotic for treatment of the client's condition. Which symptom(s) would this medication help to manage? Select all that apply. A) Alkaline urine B) Decreased deep tendon reflexes C) Hyperpyrexia D) Respiratory distress E) CNS depression
Answer: C, D Explanation: Antipsychotic medications are used in the treatment of clients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose.
The nurse is evaluating outcome goals written by a student for an alcoholic client being discharged from a detoxification program. Which outcome or outcomes now are appropriate for this client? Select all that apply. A) Follow a 2000-calorie high-carbohydrate diet. B) Sponsor a participant in Alcoholics Anonymous (AA) meetings. C) Obtain at least 6-8 hours of sleep per night. D) Acknowledge the blame that family members must take for codependent behavior. E) Enroll in the Employee Assistance Program (EAP) through his employer.
Answer: C, E Explanation: Outcome measures for a client discharging from alcohol detoxification are to obtain at least 6-8 hours of sleep a night and to enroll in the Employee Assistance Program if offered through the client's employer. The calorie requirement should be individualized and may not be 2000 calories. New or returning members to AA should be sponsored and are not ready to sponsor another person. This client should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.
A formerly homeless client has been treated for alcoholism. The client's physical examination reveals the client has a BMI of 18. Which medications does the nurse expect the physician to prescribe to manage the client's nutritional status? A) Sertraline (Zoloft) B) Methadone C) Narcan D) Multivitamin with folic acid
Answer: D Explanation: A client with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies. Narcan is used to manage an opiate overdose. Methadone is prescribed to manage heroin cravings. Sertraline (Zoloft) is used to reduce anxiety and stabilize mood.
A nursing instructor is teaching a class about the role of dopamine in substance abuse. Which student statement indicates that the role of dopamine is understood? A) "The dopamine D(1) and dopamine D(2) receptors are responsible for co-occurring disorders." B) "Dopamine increases opioid transmission, and this reinforces the cycle of substance abuse." C) "Dopamine causes changes in brain neurotransmission that enhance the cycle of substance abuse." D) "The dopamine D(3) receptor is involved in drug-seeking behaviors."
Answer: D Explanation: Although most studies have focused on the role of dopamine D(1) and dopamine D(2) receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D(3) receptor is involved in drug-seeking behavior. Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. D(1) and D(2) receptors are not responsible for co-occurring disorders.
A nurse working in an outpatient primary care clinic is caring for a client with asthma who has an 80 pack-year smoking history. What statement made by the nurse is most appropriate when assessing the client's nicotine use? A) "Have you tried a nicotine patch for quitting smoking?" B) "Do you smoke cigarettes with filters or without?" C) "Do you smoke upon waking?" D) "Tell me about any attempts you've made to quit using nicotine."
Answer: D Explanation: Appropriate assessment questions should be open-ended and allow the client to elaborate on the answers. "Tell me about any attempts you've made to quit using nicotine" is the only open-ended phrase that is effective in assessing this client.
The nurse is called to an injury accident of an employee who has a history of addiction and is currently enrolled in a 12-step recovery program. In accordance with company policy, which test will the nurse perform? A) Liver enzymes B) Stool guaiac C) Urine specific gravity D) Hair testing
Answer: D Explanation: Hair testing can detect substance use for up to 90 days. Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. Urine specific gravity is used to detect dilute or concentrated urine.
During a class for college seniors, a participant admits to frequently using alcohol. What is the priority action of the nurse? A) Initiate a community assessment of the campus. B) Contact the campus nurse and refer the student. C) Notify campus security to watch for driving under the influence. D) Complete a crisis assessment.
Answer: D Explanation: In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action. Contacting the campus nurse is not advised without the student's permission. There is no evidence that the student is driving under the influence.
The nurse is caring for a pregnant woman who admits Ecstasy use on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but what's the big deal about Ecstasy?" What should the nurse explain about Ecstasy? A) "Ecstasy use leads to deficiencies of thiamine and folic acid, which help the baby develop." B) "Ecstasy use produces babies with small heads, short bodies, and brain function alterations." C) "Ecstasy use results in intrauterine growth restriction and meconium aspiration." D) "Ecstasy use has been associated with long-term impaired memory and learning in the child."
Answer: D Explanation: Little is known about the effects of Ecstasy on pregnancy. Preliminary research does suggest that ecstasy is associated with long-term impaired memory and learning in the child. The impact on the timing of Ecstasy use by the pregnant woman during critical brain development may be a critical issue. Alcohol use, not Ecstasy use, by a pregnant woman causes deficiencies of thiamine and folic acid. Folic acid helps prevent neural tube defects. Cocaine use by a pregnant woman can cause the baby to have a small head and brain alterations. Heroin use by a pregnant woman can cause intrauterine growth restriction and meconium aspiration.
An older woman who emigrated from the Middle East lives with her son. She accompanies him to a clinic where he participates in AA. Which independent nursing action will be most helpful for the nurse to implement with this client? A) Assertiveness training B) Milieu therapy C) Family therapy D) Communication training
Answer: D Explanation: Many clients and families with addiction need training in communication skills. Verbal and nonverbal communication training is a vital independent nursing action. Cultural norms must be carefully considered prior to implementing assertiveness training. Milieu therapy and family therapy are interventions involving collaboration with therapists.
The client enters the Emergency Department with signs of drug use. The client reports having ingested Percocet. Which medications will be indicated to manage a potential overdose? A) Diazepam B) Haldol C) Vitamin B12 D) Narcan
Answer: D Explanation: Percocet is a type of opiate. Narcan is used to treat an overdose of opiates. Diazepam can be prescribed to manage signs of an overdose. Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). Vitamin B12 is used to manage the neurologic symptoms that might accompany a nitrate overdose.
The nurse has completed gathering data on a client with esophageal cancer due to years of nicotine abuse. Which nursing diagnosis is a priority for this client? A) Decisional Conflict B) Situational Social Isolation C) Disturbed Body Image D) Ineffective Airway Clearance
Answer: D Explanation: The nurse should anticipate that the client with esophageal cancer may have issues with airway edema and therefore an ineffective airway clearance. This is the priority nursing diagnosis of those listed. There is no evidence that the client has a disturbed body image or experiences decisional conflict or social isolation.
The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which client statement indicates that teaching has been effective? A) "I can continue to drink alcohol throughout my pregnancy." B) "A beer once a week will not damage the fetus." C) "I don't need to stop drinking alcohol until my pregnancy is confirmed." D) "I can't drink alcohol while breastfeeding, because it will pass into the breast milk."
Answer: D Explanation: Women should discontinue drinking alcohol when they attempt to become pregnant. It is not known how much alcohol will cause fetal damage; therefore, any amount of alcohol, even one beer, during pregnancy is contraindicated. Alcohol passes readily into breast milk; therefore, it should be avoided, or the milk should be pumped and dumped after alcohol consumption.
A 20-year-old woman is at 28 weeks' gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. Which potential fetal health problem should the nurse use to select a nursing diagnosis to guide care? A) Congenital anomalies B) Abruptio placentae C) Diabetes mellitus D) Intrauterine growth restriction (IUGR)
Answer: D Explanation: Women who use heroin place the fetus at an increased risk for developing intrauterine growth restriction (IUGR). Congenital anomalies often occur with the use of lithium during pregnancy. Diabetes is an endocrine disorder that is unrelated to drug use and abuse. Abruptio placentae is a condition the mother can experience and is seen more commonly with cocaine and crack use.
