Pharmacology Ch. 22

A patient in the emergency department says, "I am having bad effects from the marijuana I smoked this morning." The nurse formulates a response based on knowledge that effects of marijuana may last up to ____ hours.

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Which drug is least likely to produce physical dependence or tolerance? 1. Marijuana 2. Morphine 3. Nicotine 4. Ethyl alcohol

Correct Answer: 1 Rationale 1: Although psychological dependence is very high with marijuana, it has minor to no withdrawal symptoms. Rationale 2: Morphine produces withdrawal symptoms. Rationale 3: Nicotine produces withdrawal symptoms. Rationale 4: Ethyl alcohol produces withdrawal symptoms.

The patient has smoked a pack of cigarettes per day for 20 years. The patient also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include? 1. "You are at a higher risk for a heart attack than nonsmokers." 2. "The nicotine will decrease the effectiveness of your birth control pills." 3. "You are at a higher risk for developing diabetes than smokers who do not use birth control pills." 4. "You are at a higher risk for emphysema than nonsmokers."

Correct Answer: 1 Rationale 1: Cardiovascular effects can be particularly serious in patients taking oral contraceptives if they also smoke. The risk of a fatal heart attack is five times greater in smokers who also use oral contraceptives than in nonsmokers. Rationale 2: There is no evidence to support that nicotine decreases the effectiveness of oral contraceptives. Rationale 3: There is no evidence to support a correlation between diabetes, smoking, and oral contraceptives. Rationale 4: Smokers are at higher risk for emphysema, but this has nothing do with the patient's use of oral contraceptives.

The patient has been prescribed disulfiram (Antabuse) to discourage a return to drinking alcohol. The patient tells the nurse that after stopping disulfiram (Antabuse) for a week, he returned to drinking alcohol. What will the nurse most likely assess in the patient? 1. Headache, nausea, and vomiting 2. Confusion and fine tremors 3. An absence of symptoms, as the drug was discontinued 4. Severe hyperglycemia and dry skin

Correct Answer: 1 Rationale 1: If alcohol is consumed while taking disulfiram (Antabuse), the patient becomes violently ill within 5 to 10 minutes. Symptoms include headache, shortness of breath, nausea, and vomiting. Rationale 2: Confusion and fine tremors are not side effects of the combined use of alcohol and disulfiram (Antabuse). Rationale 3: Alcohol sensitivity continues for up to 2 weeks after disulfiram (Antabuse) has been discontinued. Rationale 4: Severe hyperglycemia and dry skin are not side effects of the combined use of alcohol and disulfiram (Antabuse).

The patient had been abusing cocaine for several years. Recently, the patient snorted cocaine that was much purer than was thought, resulting in an overdose. The patient died in the emergency department. What does the nurse recognize as the most likely cause of death? 1. Cardiac arrest 2. Rhabdomyolysis 3. Impurities in the cocaine 4. Bowel ischemia

Correct Answer: 1 Rationale 1: Overdose of cocaine can result in dysrhythmias, convulsions, stroke, or death due to cardiac and respiratory arrest. Rationale 2: Rhabdomyolysis would not occur with a cocaine overdose. Rationale 3: Although impurities in the cocaine could be toxic, overdose is much more likely to result in cardiac arrest. Rationale 4: Bowel ischemia would not occur with a cocaine overdose.

A patient suffering from tachycardia and palpitations would most likely be experiencing the signs of drug toxicity from which of the following? 1. Nicotine 2. Alcohol 3. Benzodiazepines 4. Marijuana

Correct Answer: 1 Rationale 1: Signs of nicotine toxicity include heart palpitations, tachydysrhythmias, confusion, depression, and seizures. Rationale 2: Signs of alcohol toxicity include somnolence and CNS depression. Rationale 3: Signs of benzodiazepine toxicity include somnolence and confusion. Rationale 4: Signs of marijuana toxicity include euphoria and paranoia.

The nurse is providing education for a patient who desires to stop taking heroin. Which information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You are probably going to have some withdrawal symptoms, but there are medications that can help you." 2. "Expect to remain on methadone for a long while." 3. "Methadone will give you the same high as the heroin you have been using." 4. "You will need a supply of syringes and needles for your methadone treatment." 5. "Methadone will not cause any withdrawal symptoms"

Correct Answer: 1,2 Rationale 1: Withdrawal symptoms are manageable with medications. Rationale 2: Some patients remain on methadone for the remainder of their life. Rationale 3: Methadone does not produce the euphoria of other opioids. Rationale 4: Methadone is an oral drug. Rationale 5: Withdrawal from methadone is more prolonged than with heroin, but the symptoms are less intense.

What is a priority outcome for the patient who has chronic alcoholism with liver damage? 1. The patient will switch to a safer drug, like a benzodiazepine. 2. The patient will become involved in Alcoholics Anonymous (AA). 3. The patient will keep all appointments with the doctor treating his liver damage. 4. The patient will learn to drink more responsibly.

Correct Answer: 2 Rationale 1: Benzodiazepines are also mood-altering substances that can be dangerous. Rationale 2: Long-term management for alcohol abuse includes behavioral counseling and self-help groups like Alcoholics Anonymous (AA). Rationale 3: Keeping all medical appointments is a good outcome but does not address the problem of the patient's continued use of alcohol. Rationale 4: Drinking more responsibly is not appropriate; the patient must abstain from all alcohol.

A patient expresses concern about becoming addicted to a prescription pain medication ordered postoperatively. What nursing responses are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The dose of your medication is as low as possible." 2. "You will only take the medication for a short time." 3. "If you follow the suggested schedule, you have little risk of addiction." 4. "If you need this medication, you cannot become addicted to it." 5. "Take the medication now, and we will worry about addiction later."

Correct Answer: 1,2,3 Rationale 1: Dose is a factor in risk of addiction. The lowest dose that will produce pain relief should be ordered. Rationale 2: Limiting the length of use of medication helps to avoid addiction. Rationale 3: Patients who follow the prescribed use of medications have low risk of addiction. Rationale 4: It is possible to become addicted to medications based on use when the patient feels the "need." Rationale 5: Ignoring the patient's concern is not therapeutic.

A nurse is preparing to admit a patient suspected of overdose. The nurse knows to suspect which drugs as being the most commonly abused? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Methylphenidate (Ritalin) 2. Nicotine 3. Marijuana 4. Amobarbital (Amytal) 5. Secobarbital (Seconal)

Correct Answer: 1,2,3 Rationale 1: Legal prescriptions such as methylphenidate (Ritalin) have become frequent drugs of abuse. Rationale 2: Nicotine is one of the most commonly abused drugs. Rationale 3: Marijuana is the most frequently abused illegal drug. Rationale 4: The medical use of barbiturates has declined, decreasing illicit abuse. Rationale 5: The medical use of barbiturates has declined, decreasing illicit abuse.

The nurse is providing community education regarding marijuana. Which information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. THC is the ingredient that causes most of the psychoactive effects. 2. Metabolites of marijuana can be detected in the urine for several days after last use. 3. Metabolites of marijuana can be detected in the body for months to years after last use. 4. The only medical use for marijuana is for glaucoma. 5. Smoking marijuana results in a greater accumulation of tar in the lungs than does cigarette smoking.

Correct Answer: 1,2,3,5 Rationale 1: Delta-9-tetrahydrocannabinol (THC) is the ingredient responsible for most of the psychoactive properties of marijuana. Rationale 2: THC remains in the urine for days after the last exposure. Rationale 3: Metabolites of THC are detectable in the body for up to years after the last use. Rationale 4: Marijuana is used for multiple medical uses such as epilepsy, multiple sclerosis, and PTSD. Rationale 5: Because marijuana smoke is inhaled more deeply and held within the lungs for a longer time, it introduces four times more tar into the lungs than tobacco smoke.

A patient has been abusing an antianxiety medication. Which assessment by the nurse would confirm this is psychological dependence instead of physical dependence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient's history reveals the long-term use of high doses of an antianxiety medication. 2. The patient describes the "need" to use the antianxiety medication despite not feeling anxious. 3. The patient describes feeling nauseous with abdominal cramping. 4. The patient tells you her family has "disowned" her because of her need for the antianxiety medication. 5. The patient complains she has not slept in days, feels anxious, and is tired.

Correct Answer: 1,2,4 Rationale 1: Psychological dependence usually requires the use of relatively high doses of antianxiety medication over a prolonged period of time. Rationale 2: Psychological dependence is the "need" or desire to continue taking a drug when there is a lack of physical symptoms. In this case, the patient does not feel anxious but still has the desire to take the antianxiety medication. Rationale 3: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence. Rationale 4: To continue the use of the antianxiety drug at the risk of jeopardizing relationships is indicative of psychological dependence. Rationale 5: Physical dependence produces physical signs of discomfort when the agent is discontinued. This is not true of psychological dependence.

The patient is withdrawing from opioids. Which symptoms best describe the results of the nurse's assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Abdominal cramping and pain 2. Positional fluctuations in blood pressure 3. Hot, dry skin 4. Goose bumps 5. Agitation

Correct Answer: 1,2,4,5 Rationale 1: Signs of opioid withdrawal include abdominal cramps and pain. Rationale 2: Orthostatic hypotension occurs during opioid withdrawal. Rationale 3: It is more likely that diaphoresis will occur. Rationale 4: Signs of opioid withdrawal include goose bumps on the skin. Rationale 5: Signs of opioid withdrawal include agitation.

The nurse is preparing care for a patient diagnosed with substance abuse of a Schedule I drug. Which drugs could be implicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Methcathinone (Cat) 2. Ritalin 3. LSD 4. Cocaine 5. Mescaline

Correct Answer: 1,3,5 Rationale 1: Methcathinone (Cat) is a schedule I drug. Rationale 2: Ritalin is a schedule II drug. Rationale 3: LSD is a Schedule I drug. Rationale 4: Cocaine is a Schedule II drug. Rationale 5: Mescaline is a schedule I drug.

A patient must eliminate caffeine intake due to contraindication with a newly prescribed medication. The nurse should advise the patient to prepare for which withdrawal symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Depression 2. Insomnia 3. Weight gain 4. Urinary retention 5. Headache

Correct Answer: 1,5 Rationale 1: Withdrawal symptoms from caffeine include depression. Rationale 2: Insomnia is more related to use of caffeine. Rationale 3: There is no direct association between decreasing caffeine intake and weight gain. Rationale 4: Urinary retention is not an issue with caffeine withdrawal.

The mother of an adolescent patient says to the nurse, "I think my son is staying up too late studying. He seems listless, and I see him using eye drops all the time for his red eyes. Should I have his vision checked?" What is the best response by the nurse? 1. "He might be depressed; insomnia is common with depression." 2. "He could be smoking marijuana, and I would talk to him." 3. "Sounds like he is using cocaine; I have seen this before." 4. "Yes, that is a great idea; he may need some glasses."

Correct Answer: 2 Rationale 1: Depression in this patient is possible, but depressed patients do not always have red eyes and do not commonly use eye drops. Rationale 2: Chronic use of marijuana is associated with a lack of motivation in achieving or pursuing life goals. One hallmark symptom of marijuana use is red or bloodshot eyes, caused by dilation of blood vessels. It is important for the parent to discuss this with the adolescent. Rationale 3: Red or bloodshot eyes are not commonly seen with cocaine abuse but are always seen with marijuana use. Rationale 4: Having the adolescent's eyes checked may indicate that the mother is in denial and that the nurse needs to be more alert to the signs and symptoms of drug abuse.

A hospice patient has been receiving oral pain medication for several weeks. The patient started with 4 mg of the drug, and each week has had to increase the amount by 2-3 mg to obtain adequate pain relief. The nurse recognizes that the patient 1. has developed immunity to the drug. 2. has developed a tolerance to the drug. 3. has developed a physiologic addiction to the drug. 4. has developed a psychological addiction to the drug.

Correct Answer: 2 Rationale 1: Drug immunity is more appropriately used when discussing the immune system. Rationale 2: Drug tolerance occurs when the body adapts to a substance after repeated administration. Rationale 3: Although addictions are possible, the situation presented best describes drug tolerance, not addiction. Rationale 4: Although addictions are possible, the situation presented best describes drug tolerance, not addiction

When an individual wants to stop using a drug but can't, she would be suffering from 1. psychological dependence. 2. substance dependence. 3. physical dependence. 4. withdrawal syndrome.

Correct Answer: 2 Rationale 1: It is unknown if this patient is psychologically dependent on this drug. Rationale 2: The question does not indicate the presence or lack of symptoms. Therefore, the more general term substance dependence is the best choice. Rationale 3: It is unknown if this patient is physically dependent on this drug. Rationale 4: Question indicates intent to stop using the drug. Withdrawal has not started.

The patient tells the nurse that her 12-year-old child asks to use her nail polish remover several times a day. When her friends come to visit, this seems to occur more frequently. What is the best response by the nurse? 1. "Your daughter may be 'huffing'; that is really scary." 2. "Your daughter may be 'huffing' or inhaling the remover." 3. "Your daughter may be 'huffing' or drinking small amounts of the remover." 4. "Your daughter may be 'huffing' or rubbing the remover on her skin."

Correct Answer: 2 Rationale 1: Telling the mother that "huffing" is scary does not give her much information and is an inappropriate response. Rationale 2: Inhaling volatile chemicals, known as "huffing," is most prevalent in the 10- to 12-year-old group. Virtually any organic compound can be huffed, including nail polish remover, spray paint, household glue, and gasoline. Rationale 3: Huffing involves inhaling volatile chemicals, not drinking them. Rationale 4: Huffing involves inhaling volatile chemicals, not rubbing them on the skin.

The patient has been abusing alcohol for several years and tells the nurse, "I used to drink a pint of whiskey every day. Now I get sick and pass out after just two drinks." What does the nurse correctly recognize about this patient? 1. The patient's symptoms are related to hyperglycemia; he may have pancreatic damage. 2. The patient may have liver damage, resulting in an inability to metabolize large amounts of alcohol. 3. The patient is in denial and is most likely minimizing the amount of alcohol he consumes. 4. The patient has brain damage from the alcohol and cannot remember how much he consumes.

Correct Answer: 2 Rationale 1: While patients with alcoholism frequently have pancreatic damage, this patient is describing a different situation. Rationale 2: Alcoholism is a common cause of cirrhosis, a debilitating, and often fatal, failure of the liver to perform its vital functions, such as metabolism of alcohol. Rationale 3: While patients with alcoholism are frequently in denial and tend to minimize the amount of alcohol they consume, this patient is describing a different situation. Rationale 4: While patients with alcoholism frequently have brain damage, this patient is describing a different situation.

The patient comes to the emergency department and tells the nurse, "I am going to get clean. I haven't had any drugs or any alcohol for 2 days." The nurse plans care based on the knowledge that withdrawal from which substance can be life threatening? 1. Heroin 2. Alcohol 3. Cocaine 4. Marijuana

Correct Answer: 2 Rationale 1: Withdrawal from heroin is very unpleasant, but it is not life threatening. Rationale 2: Alcohol withdrawal syndrome is severe and may be life threatening. Rationale 3: Withdrawal from cocaine is uncomfortable, but it is not life threatening. Rationale 4: There is virtually no withdrawal from marijuana.

Which questions would the nurse ask to assess for the presence of user-related factors in a patient with substance use disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "How many friends do you consider to be reliable?" 2. "Does anyone in your family have a substance use disorder?" 3. "Have you had any disorders for which you have taken prescription pain medications?" 4. "What is the highest level of education you completed?" 5. "How much disposable income do you have?"

Correct Answer: 2,3 Rationale 1: Peer influences are an environmental factor. Rationale 2: Genetics is a user-related factor. Rationale 3: Disorders that require a prescription pain medication are user-related factors. Rationale 4: Educational level is an environmental factor. Rationale 5: Income relates to cost of drug, which is a factor related to the agent or drug.

The nurse manager is presenting an educational session on the issue of substance use disorder and nurses. The manager would focus information on which substances? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Barbiturates 2. Benzodiazepines 3. Alcohol 4. Hallucinogens 5. Opioids

Correct Answer: 2,3,5 Rationale 1: Barbiturates are not a substance of choice for this population. Rationale 2: Benzodiazepines are a substance of choice for this population. Rationale 3: Alcohol is a substance of choice for this population. Rationale 4: Hallucinogens are not a substance of choice for this population. Rationale 5: Opioids are substances of choice for this population.

The nurse is managing care for a group of patients with substance use disorder. The patients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the patients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Heroin addicts often die from heroin withdrawal." 2. "Substance abuse depends on complex variables." 3. "Most addicts became addicted from pain medication in a hospital." 4. "Addiction includes a compulsion to use a mood-altering substance." 5. "There is most likely a genetic component to addiction."

Correct Answer: 2,4,5 Rationale 1: While extremely unpleasant, withdrawal from opioids is typically not life threatening. Rationale 2: Substance abuse depends on multiple, complex, interacting variables. Rationale 3: Prescription drugs rarely cause addiction when used according to accepted medical protocols. Rationale 4: Addiction is an overwhelming compulsion that drives someone to repetitive drug-taking behavior, despite serious health and social consequences. Rationale 5: Children of alcoholic parents are four times more likely to become alcoholics than children of nonalcoholic parents.

The adolescent patient is in a drug rehabilitation program. The mother of this patient says to the nurse, "The doctor said my son has a physical addiction to alcohol. What does this mean?" What is the best response by the nurse? 1. "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it." 2. "He will have an intense craving for alcohol; this is best managed in group therapy." 3. "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped." 4. "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide."

Correct Answer: 3 Rationale 1: Alcohol does produce euphoria, but a craving for the substance is not a medical issue. Rationale 2: Psychological dependence, or craving, does not involve physical withdrawal symptoms. Rationale 3: Over time, the body's cells become accustomed to the presence of the unnatural substance. Specific, physical withdrawal symptoms will occur; the patient needs to be medically withdrawn from the substance. Rationale 4: Depression may accompany physical withdrawal, but physical signs are what require medical management.

The nurse would expect to see which withdrawal symptoms from a patient who abuses alcohol? 1. Lethargy, constipation, light sensitivity, and weight loss 2. Anxiety, seizures, hearing loss, and alopecia 3. Tremors, anxiety, confusion, and delirium 4. Abdominal pain, chills, pupil dilation, and lethargy

Correct Answer: 3 Rationale 1: Lethargy, constipation, light sensitivity, and weight loss are not commonly associated with alcohol withdrawal. Rationale 2: Anxiety, seizures, hearing loss, and alopecia are not commonly associated with alcohol withdrawal. Rationale 3: Common withdrawal symptoms associated with alcohol include tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, and delirium. Rationale 4: Abdominal cramping may occur, but chills, pupil dilation, and lethargy are not commonly associated with alcohol withdrawal.

The patient is admitted to the in-patient substance abuse unit. She tells the nurse she has been buying "yellow jackets" (pentobarbital, [Nembutal]) on the street but hasn't had any for a few days. What is the best plan by the nurse at this time? 1. Prepare to manage the depression and suicidal thoughts the patient will have. 2. Prepare to do frequent room searches, as the patient's friends will most likely bring drugs in for her. 3. Prepare to manage a withdrawal that could be life threatening. 4. Prepare to manage a withdrawal that will likely be minimal.

Correct Answer: 3 Rationale 1: Physical needs have priority over psychological needs, such as depression, in this case. Rationale 2: Doing room searches is a good idea, but preparing for withdrawal is a higher priority. Rationale 3: Barbiturates are central nervous depressant (CNS) drugs. Withdrawal symptoms resemble those of alcohol withdrawal and may be life threatening. Rationale 4: Withdrawal from barbiturates will more likely be life threatening, not minimal.

During a health history, the nurse should use therapeutic communication when asking about substance abuse. Which of the following is essential to establish a trusting nurse-patient relationship? 1. Informing the patient that substance abuse is a sin 2. Avoiding communicating disapproval of indicated substance abuse 3. Ensuring that the patient's mother and father are at the bedside 4. Avoiding shocked facial expressions

Correct Answer: 4 Rationale 1: Informing the patient that substance abuse is a sin is being judgmental. Rationale 2: The nurse should firmly communicate disapproval of any indicated substance abuse. Rationale 3: Patients might be less likely to inform the nurse of a hidden substance abuse problem in the presence of family members. Rationale 4: The nurse should be nonjudgmental.

The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon? 1. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient. 2. The patient has developed a paradoxical reaction to the anesthesia and will require a different drug. 3. The patient has developed a resistance to the anesthesia, so it will not work very well. 4. The patient has developed cross-tolerance to the anesthesia and will require higher amounts.

Correct Answer: 4 Rationale 1: There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose. Rationale 2: Paradoxical refers to the opposite response; in this case, the patient would have become very excitable; there is no evidence of this. Rationale 3: Resistance refers to the immune system and infections and should not be used interchangeably with tolerance. Rationale 4: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants.

The nurse is reinforcing factors that contribute to addiction to a group of patients recovering from addiction and their family members. Which statement made by a patient or family member would indicate the need for additional teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction." 2. "I can still see my friends as long as I stay away from alcohol." 3. "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to." 4. "I realize now that I was just looking for ways to help me feel good about myself." 5. "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills."

correct Answer: 1,2,3 Rationale 1: Addiction depends on multiple and complex variables. Genetics plays a part, but many other factors also contribute to addiction. Rationale 2: Counselors encourage users to stop associating with social contacts who shared the substance abuse to lessen the possibility for relapse. Rationale 3: The therapeutic use of drugs rarely causes addiction when used according to accepted medical protocols. Rationale 4: The drug experience may bring feelings of pleasure or well-being. The patient may find achieving this feeling to be worth repeating, leading to addiction. Rationale 5: This patient recognizes that taking pain medication even when in not pain leaves one vulnerable for addiction. The therapeutic use of drugs rarely causes addiction when used according to accepted medical protocols.