Quiz 2 Material
A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? Select all that apply: 1. "Express your love and your belief that he can change." 2. "Point out that his behavior is his choice and his responsibility." 3. "Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important." 4. "Remind him that entering treatment is better than going to prison."
1, 2
Which of the following are therapeutic skills to develop and express empathy for a patient? (Select all that apply) 1. Good eye contact 2. Responsive facial expression 3. Active listening body language 4. Verbal and non-verbal "encouragers" such as nodding one's head and saying "Hmm go on." 5. Reflective listening statements like "You are feeling____." 6. Expressing doubt 7, Expressing concern and judgment
1, 2, 3, 4, 5
The CIWA alcohol withdrawal assessment tool assesses the presence of which of the following? (Select all that apply) 1. Nausea/Vomiting 2. Auditory Disturbances 3. Visual Disturbances 4. Tactile Disturbances 5. Diaphoresis 6. Depression 7. Headache 8. Paranoid Ideation 9. Thought Content 10. Short-term memory 11. Anxiety 12. Orientation to person, place, situation
1, 2, 3, 4, 5, 7, 11, 12
Opioid withdrawal
diarrhea pain ...
What effect does chronic stress have on prefrontal cortex
shrinks PFC
Respiratory depressant effects of alcohol
slow, shallow breathing decreases respiratory rate
Absorption is faster than
metabolism
How do we chart substance abuse disorder?
replace substance with the class of the drug e.g. Opioid Use Disorder
How is opioid withdrawal treated
Tylenol
What is the toxic bi product of alcohol breakdown
Acetaldehyde
Quicker-sicker pattern in women
women become sicker quicker This has to due with the fact that women generally weigh less and have different enzyme activity
Protective factors against Alcohol use disorder
worse toxic bi product when ingesting even a small amount of alcohol --> not wanting to drink -occurs in Chinese, Chinese Americans, and African Americans
How do we prevent addiction to benzodiazepines during alcohol withdrawal treatment
taper benzos
Which of the following are accurate about alcohol withdrawal? (Select all that apply): Signs and symptoms of withdrawal typically begin 4-12 DAYS after alcohol use has stopped or reduced. Withdrawal usually peaks at day two and improves with treatment around days 4-5. Less than 10% develop delirium but it is a risk factor for mortality. Less than 3% develop grand mal seizures but benzodiazepine protocols are used as prophylaxis. Withdrawal protocols are based on symptoms of active withdrawal such as tremors. Clonidine (Catapres) is another common medication used to manage elevated vital signs and withdrawal symptoms.
2, 3, 4, 5, 6
A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, dizziness and sweating. Active use of which drugs could potentially account for these symptoms? Select all that apply: 1. Alcohol 2. Ecstasy (MDMA) 3. Methylphenidate 4. Marijuana 5. Huffing household cleaning substances
2, 3, 5
A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to do which of the following? Select all that apply: 1. avoid aged cheeses. 2. avoid alcohol-based skin products. 3. read labels of all liquid medications. 4. wear sunscreen and avoid bright sunlight. 5. maintain an adequate dietary intake of sodium. 6. avoid breathing fumes of paints, stains, and stripping compounds.
2, 3, 6
An MD has ordered a CIWA-Ar tool (Clinical Institute for the withdrawal from alcohol-revised) to be used as part of an alcohol detoxification protocol. You know that the CIWA-Ar is assessed on a numerical scale. Which of the following are true regarding the CIWA-Ar scale? (Select all that apply) 1. the highest score is 75. 2. the highest score is 67. 3. a score of 0-9 indicates severe withdrawal 4. a score of 0-9 indicates absent or minimal withdrawal 5. the higher the score, the more medication is given 6. a score > 35 indicates a possible transfer to the ICU 7. a patient who receives more than 8 mg of Lorazepam or 5mg of 8. Diazepam in 3 hours is a candidate for ICU level of care. a patient in alcohol withdrawal who receives benzodiazepines should be assessed for respiratory depression. 9. there are 10 parameters that are assessed 10. vital signs are part of the determination about how much medication is given
2, 4, 5, 6, , 9, 10
Too much dopamine is associated with
psychotic disorders e.g. Schizophrenia
Substance Use Disorder
- Maladaptive pattern of use - Significant impairment and/or distress + Within 12 month period, 2+ sxs: - Recurrent use and faillure to fufill major role obligations -Recurrent use in physically hazardous situations -Craving or a strong desire to urge to use substance -Continued use despite social/interpersonal problems from use -Tolerance-need for more to get same effect -Withdrawal-cognitive and physical effects w/ lower drug amt -Taken in larger amounts or over longer time period than intended -Persistent unsuccessful efforts to stop/cut down or control use -Great deal of time spent in efforts to obtain substance - Social, Work, Activities etc. given up or reduced d/t use -Cont. use despite knowledge of problem (psych or physical sxs
PFC Abnormalities can lead to what mental health disorders
-ADD/ADHD -Psychoses, suicide, personality disorders
Who is at increased risk for Alcohol Use Disorder
-Children of alcoholics -Male
Delirium Treatments **Medical Emergency
-acute delirium (confusion, disorientation, global confusion, severe memory disturbance) -severe tremors, agitation, sense of impending doom, paranoia, delusions, AH, VH, TH, nightmares -N/V/D, anorexia, diaphoresis, fever, tachycardia, HTN, seizures, coma, death -elevated vital signs
Alcohol physical effect short term
-apathy/decreased anxiety decreased balance, refexes, judgement
Alcoholic hallucinations: Psychosis
-develops/resolves rapidly -involves ego-dystonic AH and VH (most common accusatory, threatening voices)
Features of fetal alcohol syndrome
-facial anomalies, low birth weights, heart defects, growth deficits -Brain damage: hyperactive, problems with learning etc
Long term effects of alcohol
-high morbidity and morality r/t loss of coordination, falls -lower inhibitions; accidents **respiratory depression, PNA's, aspiration, OD -Alcohol-induced depression or anger -aggravation of mental conditions
According to the Recovery Model of SUDs, the term 'Recovery' means which of the following? For more info, please review to the assigned brief video clip (per the module assignment): https://media.usfca.edu/app/plugin/embed.aspx?ID=-YUBpbSjVEOnwZSxGvBbxgLinks to an external site. (Select all that apply): a process of change through which individuals improve their health and wellness to reach their full potential through a focus on personal responsibility, individual strengths and hope. a non-linear process of change through which individuals are the experts of their experience and strive to live a self-directed life through support and personal empowerment. a process of change through which nurses and health-care professionals play a partner or coaching role. a process of change through which health-care professionals are the experts and instruct, educate and push patients towards healthy choices. a process of change that involves peer support, holistic and person-centered care in an integrated system where nurses collaborate with other disciplines to provide optimal patient care. a process that views the patient with SUDS as a 'mental health problem'. a process that expects that realistically patients will not likely recover fully. a model that allows nurses to discuss patients in private differently than how they would directly address the patient in person.
1, 2, 3, 5
In a Motivational Interviewing approach, readiness for change involves which of the following tools? (Select all that apply) 1. The nurse's use of empathy. 2. A review of the patient's view of the pro's and con's of his/her use. 3. Resolving the patient's ambivalence towards reducing or stopping his/her use of substances. 4. Use of direct confrontation, by calling out the patient's problem with drugs or alcohol. 5. Rolling with the patient's denial and resistance to stop using his/her drug. 6. Developing discrepancy about the patient's current behaviors and what the patient's own goals are.
1, 2, 3, 5, 6
A nurse implementing a CIWA-Ar alcohol detox protocol for a patient in alcohol withdrawal will often give which of the following benzodiazepine medications to safely detox the patient? (Select all that apply): 1. Ativan (Lorazepam) 2. Librium (Chlordiazepoxide) 3. Buspar (Buspirone) 4. Lithium (Lithobid) 5. Clozaril (Clozapine) 6. Klonopin (Clonazepam) 7. Valium (Diazepam)
1, 2, 6, 7
A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? Select all that apply: 1. A combination of interventions, beginning with changing the environment . 2. Acupuncture or Chantix alone as monotherapy to reduce the nicotine cravings. 3. Behavior modification through hypnosis with support and possibly medications. 4. Nicotine replacement products such as the Nicotine patch. 5. Wellbutrin (Buproprion, Zyban) with lifestyle modification and support.
1, 3, 4, 5
During the 'Brief Intervention' (BI) of an SBIRT approach to SUDs, the use of Motivational tools includes which of the following? (Select all that apply): A collaborative, compassionate and respectful way of being with the patient. A confrontational approach that assumes that the healthcare professional is the expert. A partnership between the patient and nurse where the nurse tries to understand the patient's experience and perspective. The nurse's use of OARS (open-ended questions, affirmations or statements and reflective listening) to praise positive behaviors and support the person when describing difficult situations. Use of specific techniques to trick the patient into doing what you want them to do. A nurse's support of the patient's skills and strengths. A nurse who establishes rapport with a patient. A nurse who respectfully evokes a patient's thoughts, feelings, concerns, goals and motivations. A nurse who assertively sets the agenda for the patient by telling the patient how drinking is unhealthy and the health risks that it causes.
1, 3, 4, 6, 7, 8
The nurse can assist a patient to prevent substance use relapse by which of the following? Select all that apply: 1. rehearsing techniques to handle anticipated stressful situations. 2. advising the patient to accept residential treatment if relapse occurs. 3. assisting the patient to identify life skills needed for effective coping. 4. advising isolating self from significant others until sobriety is established. 5. informing the patient of physical changes to expect as the body adapts to functioning without substances.
1, 3, 5
A nurse is applying secondary prevention for a client for Substance Use Disorders (SUDs). Which of the following actions would the nurse most likely complete? Select all that apply: 1. Assist with identifying help or resources. 2. Advise about the need to enter a treatment program. 3. Ask about how relationships with family members and friends have been affected. 4. Assess amount and pattern of use. 5. Use a tool such as the CAGE or MAST scale.
1, 4, 5
What are the two enzymes that break down alcohol
1. Alcohol Dehydrogenase ADH 2. Aldehyde Dehydroxyenase ALDH
Which of the following statements accurately describes why methadone is used to treat heroin addiction? Select all that apply: 1. Addicts prefer Methadone instead of heroin. 2. Methadone blocks the effects of heroin and reduces the craving. 3. Methadone prevents further dependence on drugs. 4. Methadone gives an enjoyable high, so addicts continue treatment. 5. Methadone is a harm-reduction approach since it is regulated and considered less harmful than street drugs.
2, 5
From a Motivational Interviewing perspective, choose which of the following are the correct use of open-ended questions. (Select all that apply): 1. So, you are here because you are concerned about your alcohol, correct? 2. Tell me, what if anything, concerns you about your alcohol use? 3. Do you agree that you have a problem and it would be a good idea to go into treatment? 4. Do you feel anxious or depressed? 5. Does anyone you know have a problem with your drinking? 6. What do you think you want to do about your drinking? 7. What are some things that you like about smoking marijuana? 8. Tell me about your family and any concerns that they may have. 9. How have you been feeling? 10. What do you think about the possibility of going for treatment?
2, 6, 7, 8, 9, 10
Which of the following is an accurate concern about the use of marijuana? Select all that apply: 1. Marijuana has painful withdrawal symptoms. 2. Marijuana may damage the respiratory tract. 3. Marijuana can often reduce pain but physicians refuse to prescribe it. 4. Marijuana quickly leads to psychological and physiological dependence. 5. Use of Marijuana at a young age is associated with the development of psychotic symptoms.
2,5
Which of the following are true of the CAGE? (Select all that apply): It is a 5-item screening instrument to determine whether or not a patient should be hospitalized in a 'cage' or locked unit. It is a 4-item screening tool to assess the risk of amphetamine use disorders. It is a 4-item questionnaire to screen for the possibility of alcohol use problems. The screening questions include the client's annoyance regarding others' criticism of their drinking, any efforts made to cut the drinking down, having a morning drink to relieve withdrawal or hangover symptoms and guilt about their alcohol use. The higher the score the less likely the person is an alcoholic. A score of 2 or higher indicates a need for more in-depth screening. C is for Clarity of thinking, A is for Acceptance, G is for Gaining strength & E is for Empowerment.
3, 4, 6
A male IDU (injection drug user) admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? Select all that apply: 1. Primary prevention by educating about safe injections. 2. Primary prevention by avoidance of future legal complications. 3. Secondary prevention to reduce the risk for infection or other complications. 4. Tertiary prevention to reduce the transmission of blood-borne diseases. 5. Harm Reduction to minimize complications to the client and community.
4, 5
A patient took a large quantity of the designer drug, 'psychoactive bath salts' (PABS). A nurse is familiar with the risks associated with this street drug. Priority nursing and medical measures include which of the following? Select all that apply: 1. administration of naloxone (Narcan). 2. vitamin B12and folate supplements. 3. restoring nutritional integrity. 4. management of heart rate. 5. environmental safety.
4, 5
Which of the following are considered an Empathic approach by the nurse working with a patient who is using substances? (Select all that apply) 1. The nurse sharing common past experiences with the patient. 2. The nurse giving advice, making suggestions, or providing solutions to the patient. 3. The nurse asking a lot of questions. 4. The nurse's self-disclosure of a personally similar experience with the patient. 5. The nurse agreeing with the patient. 6. The nurse listening and offering statements that reflect an accurate understanding of the patient's experience. 7. The nurse perceiving the patient's experience in a non-judgmental way from the patient's perspective. 8. The nurse understands and reflects back the patient's feelings and words in a warm, supportive manner. 9. Trying to help the patient by pointing out their mistakes and offering suggestions for appropriate solutions.
6, 7, 8
Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" The nurse's best response is which one? A. "Make your loved one responsible for the consequences of behavior." B. "It's important that you visit your family member on a regular basis." C. "Alcoholism is a lifelong disease. Relapses are expected." D. "Use search and destroy tactics to keep the home alcohol free."
A. "Make your loved one responsible for the consequences of behavior."
A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min0400: 126/80 mm Hg and 76 beats/min0600: 128/82 mm Hg and 72 beats/min0800: 132/88 mm Hg and 80 beats/min1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? A. Consult the health care provider. B. Obtain a clean-catch urine sample. C. 5150 the patient. D. Place the patient in a vest-type restraint. E. Force fluids.
A. Consult the health care provider.
Which of the following approaches has research suggested is the most effective way to approach substance use disorders (SUDs)? A. Harm reduction B. Criminal justice system C. Punishment approach D. Substance abuse education E. Zero tolerance
A. Harm reduction
In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication.Which one is the priority outcome? A. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. B. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. C. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields. D. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department.
A. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.
What to drugs have the highest withdrawal risk?
Alcohol and Benzodiazepine withdrawal
Wernicke's encephalopathy (Dementia)
Ataxia, nystagmus, confusion
A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? A. Cardiovascular B. Respiratory C. Hepatic D. Endocrine E. Neurologic
B. Respiratory
Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? A. How to recognize and overcome peer pressure to continue bad habits. B. The fact that tobacco smoking causes more deaths than any other behavior in the United States. C. How students can learn to "just say no" when offered drugs or drinks. D. A discussion of which drugs are commonly used on campus.
B. The fact that tobacco smoking causes more deaths than any other behavior in the United States.
Why can Chronic alcohol use lead to peripheral neuropathy
B1 (Thiamine) deficiency -peripheral pain
How is delirium tremens/alcohol withdrawal treated
Benzodiazepines
A hospitalized patient diagnosed with an alcohol use disorder believes that spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? A. Keep the room dimly lit. B. Force fluids. C. One-on-one supervision. D. Check the patient every 15 minutes. E. Immediately place physical restraints on the patient.
C. One-on-one supervision.
A school health nurse is asked by a parent group to explain risk factors for Substance Use Disorders (SUDs). Which one of the following information should the nurse include? A. Alcoholism is a disease of willpower. B. SUDs are determined primarily by the family environment. C. SUDs are determined partly by genetic factors. D. Persons born with fetal alcohol syndrome are alcoholics from birth. E. Persons who use substances are usually women
C. SUDs are determined partly by genetic factors.
A man is addicted to alcohol. In which of the following scenarios is a family member enabling the man to continue drinking? A. The teenage daughter turns to a favorite teacher for emotional support. B. The wife asks the nurse to explain why her husband's continued drinking is dangerous. C. The wife tells her husband's boss that her husband is sick when he is actually inebriated. D. The son threatens to leave home because he finds the father's behavior embarrassing.
C. The wife tells her husband's boss that her husband is sick when he is actually inebriated.
A hospitalized patient diagnosed with an alcohol use disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe which one of the following? A. a monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil). B. a narcotic analgesic, such as hydromorphone (Dilaudid). C. a sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). D. an antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). E. the medication, Antabuse (Disulfram).
C. a sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium).
Korsakoff's Syndome
Chronic Alcohol Use Short term memory disturbance r/t Thiamine deficiency (Vit B1) --> damage to Hippocampus) --> Wernicke's
True or False? According to the evidence-based approach, SBIRT (Screening, Brief Intervention & Referral to Treatment) when working with those with substance use disorders (and other problems), there is not much that health care professionals can do until a person is motivated to change. True OR False
False
A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Which is the nurse's best response? A. "You must make a commitment to permanently abstain from alcohol and other drugs." B. "The goal of AA is for members to learn controlled drinking with the support of a higher power." C. "You will be assigned a sponsor who will plan your treatment program." D. "An individual is supported by peers while striving for abstinence one day at a time."
D. "An individual is supported by peers while striving for abstinence one day at a time."
A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse? A. "I'm so sorry to hear that. Is your mother able to be with you?" B. "You must hate him for leaving you alone with a new baby!" C. "It's good that you and the baby are safe from him." D. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?"
D. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?"
Three women were brought to the emergency department (ED) by ambulance after a two-car accident at a busy intersection. Which one of these tests should automatically be done under such circumstances? A. Breathalyzer B. AST, ALT C. CBC with diff D. BAL E. CPK
D. BAL
A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when the other passes out and cannot continue? A. If they play fair, they'll probably both vomit before passing out. B. The woman will win because females metabolize alcohol more slowly than men. C. If their drinks are the same size, they'll both pass out about the same time. D. The man will win.
D. The man will win.
prefrontral cortex
Executive function: critical thinking, planing, risk evaluation
Liver disease
Leading cause of death r/t chronic use of etoh --> encephalopathy, bleeding/clotting problems, peripheral neuropathy
What improves PFC fn.?
Mindfulness
Fetal Alcohol Syndrome
Most common preventable cause of mental impairment
Too little dopamine can lead to what mental health disorders
Parkinson's disease, possibly obesity, ADHD, chronic drug use (can lead to less endogenous DA production)
True or False? The primary goal of SBIRT is to identify and effectively intervene with those who are at moderate to high risk for psychosocial or health care problems related to their substance use.
True
What vitamin should be given during Alcohol withdrawal
Vitamin B1 multivitamin is a supplement that is given during alcohol withdrawal to prevent Wernick's encephalopathy IM day 1 --> PO
Drug follow up questions
What drugs are you taking? What specific drug within category? (e.g. vodka vs beer) Route?
A patient diagnosed with an alcohol use disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Tell me what happened the last time you drank." b. "If you were coping so well, why were you hospitalized again?" c. "I hear a lot of defensiveness in your voice. Do you really believe this?" d. "Sooner or later, alcohol will kill you. Then what will happen to your children?"
a. "Tell me what happened the last time you drank."
According to the stages of change theory, a person who is currently abusing substances and is in denial of the problem and not ready for change, is in which stage of change? a. Pre-contemplative stage b. Action stage c. Planning stage d. Contemplative stage e. Resistance stage
a. Pre-contemplative stage
A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Self-assess personal attitude, values, and beliefs about this health problem. b. Perform a thorough assessment of the patient. c. Obtain a face shield because oral hygiene is poor in methamphetamine abusers. d. Verify that security services are immediately available.
a. Self-assess personal attitude, values, and beliefs about this health problem.
Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Confrontational and challenging c. Stimulating and colorful d. Active and bright
a. Simple and safe
A newly admitted client is experiencing acute alcohol withdrawal. The Nurse Practitioner (NP) orders a CIWA (Clinical Institute Withdrawal Assessment). Today is day 1. The client's vital signs are elevated for the first 2 days. Whenever the client has elevated vitals (BP, Resp rate, Pulse & Temp), it is assumed that the Ativan is given. Standing Orders: Give lorazepam (Ativan) 0.5 mg QID (4x/day or every 6hrs) for 5 days. Complete the CIWA Q 4 hours (6x/day) for 5 days with the benzodiazepine detox protocol. Also, give lorazepam (Ativan) PRN Q 4 hours (as per NP orders) based on the following standing orders scale: CIWA score 0-7: 0 mg (Do not give any Ativan PRN) CIWA score 8-15: Give Ativan 0.5mg CIWA score >15: Give Ativan 1.0mg The client's CIWA scores are as follows: Time: Score: 04:00 6 (at admit) 08:00 14 12:00 8 16:00 12 20:00 15 24:00 7 04:00 16 How many total __mg of lorazepam (Ativan) did the client receive in the first day (24hrs)? a. 8 mg b. 5 mg c. 2 mg d. 6 mg e. 3 mg
b. 5 mg
A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Use of which substance is most likely? a. Barbiturates b. Amphetamines c. Alcohol d. PCP e. Heroin
b. Amphetamines
You, the nurse are assessing a tremulous medical surgical patient who was admitted earlier today for chronic pancreatitis. You notice that the admitting physician forgot to add an important assessment in the chart. Understanding a major cause of pancreatitis, you advocate for which assessment tool to be ordered for this patient? a. COWS (Clinical Opiate Withdrawal Scale) b. CIWA-Ar (Clinical Institute for the Withdrawal of Alcohol-revised version) c. SAWS (Severity of Alcohol Withdrawal Scale) d. AIMS (Abnormal Involuntary Movement Scale) e. GCS (Glascow Coma Scale) f. GDS (Geriatric Depression Scale)
b. CIWA-Ar (Clinical Institute for the Withdrawal of Alcohol-revised version)
A patient who has a substance use disorder and is more open to hearing about the benefits of quitting their substance is in which stage? a. Pre-contemplative stage b. Contemplative stage c. Action stage d. Planning stage e. Maintenance stage
b. Contemplative stage
A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. American Society of Addictions Medicine (ASAM) b. Substance Abuse and Mental Health Services Administration (SAMHSA) c. National Council of State Boards of Nursing (NCSBN) d. Institute of Medicine - National Research Council (IOM)
b. Substance Abuse and Mental Health Services Administration (SAMHSA)
The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should do which one of the following? a. first treat the schizophrenia, then establish goals for substance abuse treatment. b. consider each diagnosis primary and provide simultaneous treatment. c. provide long-term care for the patient in a residential facility. d. withdraw the patient from cannabis, then treat the schizophrenia.
b. consider each diagnosis primary and provide simultaneous treatment.
A medical surgical patient is admitted for acute gastritis and you suspect it is related to chronic alcoholism. The patient is currently A &O X 4 but complains of intermittent nausea, moderate anxiety, a moderate headache, and moderate itching/pins and needles sensations in his extremities. The patient appears moderately fidgety and restless and complains of moderate sensitivity to light. You observe obvious diaphoresis on his forehead. He denies any other symptoms. You notice that he has severe tremors of both arms while they are resting on his stomach and his VS are all elevated. Which one would be the most accurate total score assigned for this patient using the CIWA-Ar? a. 40 b. 10 c. 34 d. 24 e. 18
c. 34
Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Disulfiram (Antabuse) b. Clonidine (Catapres) c. Naltrexone (ReVia) d. Methadone (Dolophine) e. Bromocriptine (Parlodel)
c. Naltrexone (ReVia)
Alcohol Use Disorder
central nervous system depression
A patient with an antisocial personality disorder (ASPD) was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. Long-term outpatient therapy b. 1-week detoxification program c. Residential program d. 12-step self-help program
c. Residential program
Symptoms of withdrawal from opioids for which the nurse should assess include which one of the following list of symptoms? a. mood lability, incoordination, fever, and drowsiness. b. excessive eating, constipation, and headache. c. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. d. dilated pupils, tachycardia, elevated blood pressure, and elation.
c. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.
Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will do which one of the following? a. develop a trusting relationship with one staff member. b. use denial and rationalization in healthy ways. c. state, "I know I need long-term treatment." d. identify constructive outlets for expression of anger.
c. state, "I know I need long-term treatment."
A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Which is the most accurate assessment of this patient? a. the patient is attempting to obtain attention by manipulating staff. b. the patient may have sustained a head injury before admission. c. the patient has symptoms of alcohol-withdrawal delirium. d. the patient is having an acute psychosis.
c. the patient has symptoms of alcohol-withdrawal delirium.
During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." b. "It is good that you are supportive of your spouse's sobriety and want to help maintain it." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."
d. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."
Which goal for treatment of alcoholism should the nurse address first? a. Develop a peer support system. b. Develop alternate coping strategies. c. Learn about addiction and recovery. d. Achieve physiologic stability.
d. Achieve physiologic stability.
Which assessment findings are likely for an individual who recently injected heroin? a. Heightened sexuality, insomnia, euphoria b. Muscle aching, dilated pupils, tachycardia c. Anxiety, restlessness, paranoid delusions d. Drowsiness, constricted pupils, slurred speech
d. Drowsiness, constricted pupils, slurred speech
Which one of the following is the most therapeutic approach for a nurse working with a patient beginning treatment for alcohol addiction? a. Skeptical, guarded b. Cool, distant c. Confrontational d. Empathetic, supportive
d. Empathetic, supportive
Which one is the priority nursing intervention when caring for a patient after an overdose of amphetamines? a. Observe for depression. b. Use warmers to maintain body temperature. c. Awaken the patient every 15 minutes. d. Monitor vital signs.
d. Monitor vital signs.
A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Ineffective denial b. Disturbed sensory perception c. Ineffective coping d. Risk for injury
d. Risk for injury
When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Metabolism of the alcohol is now delayed. b. Antagonistic effects are evident. c. Pharmacokinetics of the alcohol have changed. d. Tolerance has developed.
d. Tolerance has developed.
Using an SBIRT approach, choose which one from the following examples is the correct first step? a. Listen to the patient b. Recommend that the patient stop drinking alcohol due to their medical problems. c. Refer the patient to AA d. Universally screen all patients in community settings and those who have risks screen further using a validated tool such as the DAST or AUDIT (by the WHO). e. Only screen those who admit to using alcohol or drugs.
d. Universally screen all patients in community settings and those who have risks screen further using a validated tool such as the DAST or AUDIT (by the WHO).
According to the evidence, motivation to change one's behavior in a positive way is most influenced by which one of the following? a. court-mandated treatment b. legal threats of jail or prison time c. financial incentives for staying clean and sober d. human connections e. hitting 'rock bottom' such as a from a significant crisis
d. human connections
injection drug users (no matter the type) with fever should have an immediate work up for...
infection e.g. endocarditis
How to ask patients what drugs they are taking
open-ended "what do you use"
