Addiction: Exemplar 22.B Nicotine Addiction
A nurse is caring for a client with congestive heart failure (CHF) who currently smokes cigarettes and has a 50 pack-year smoking history. When providing smoking cessation education to this client, which statements regarding the pathophysiology of nicotine use are appropriate? 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 intake appears to be the best method of cessation."
AC
The nurse is planning care for a client with esophageal cancer caused by years of nicotine abuse. Which of the following would be the priority nursing diagnosis for this client? A) Decisional Conflict B) Social Isolation C) Disturbed Body Image D) Ineffective Airway Clearance
D
An 80-year-old client with heart disease tells the nurse, "I am sick because I sinned by smoking cigarettes." Which response by the nurse is appropriate? A) "Smoking cigarettes isn't a sin. There are many worse habits you could have." B) "Cigarette smoking was socially acceptable when you began smoking. People didn't fully understand 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."
B
The nurse is teaching a class of adolescents about smoking. Which of the following points is most important to convey to this audience? A) Teenagers and young adults are not strongly influenced by tobacco advertising. B) Smoking is a major cause of lung cancer. C) Increasing the cost of cigarettes is not an effective deterrent to smoking. D) Few young people who smoke regularly during their teenage years continue to use tobacco as adults.
B
Why is smoking particularly dangerous for clients with atherosclerosis? A) Smoking causes a direct increase in HDL cholesterol, which further contributes to plaque buildup. B) Smoking causes vasoconstriction, which further impairs tissue oxygenation. C) Smoking causes a direct increase in total cholesterol, which further contributes to plaque buildup. D) Smoking causes a decrease in blood pressure, which further impairs tissue oxygenation.
B
The nurse is providing care to a client who admits to smoking two packs of cigarettes per day for 34 years. The client also has a history of intermittent claudication, chronic bronchitis, and emphysema. After 6 weeks of smoking cessation, the client reports that he is frequently "yelling" at his spouse and "flying off the handle." Which effects of cigarette smoking are associated with the data the nurse has collected from the client? Select all that apply. A) Nicotine causes destruction of the alveoli. B) Smoking triggers the release of epinephrine, which causes vasoconstriction. C) Dopaminergic processes are implicated in nicotine withdrawal. D) The tar in cigarettes can cause the mucus production seen in chronic bronchitis. E) Tobacco use leads to atherosclerosis.
BCDE
The nurse is providing education to a client who wants to quit smoking. Which statements are appropriate for the nurse to include in the teaching session? Select all that apply. A) "There is no adverse risk if you choose 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 people quit smoking several times before they are successful." E) "Alternative therapies can help reduce the stress that accompanies smoking cessation."
BDE
A nurse is caring for a client who smokes cigarettes and wants information about nicotine replacement therapy (NRT). Which statement is appropriate for the nurse to include in the teaching session? A) "Over-the-counter NRT products include transdermal patches, gums, nicotine inhalers, and nasal sprays." B) "NRT helps relieve the psychologic and physiologic effects of nicotine withdrawal." C) "NRT does not address addictive behavior." D) "Using NRT in conjunction with a smoking cessation program is no more effective than using NRT alone."
C
A nurse works at a clinic that provides care to a community with a high population of smokers. The nurse is planning an educational session entitled "Tips for Quitting." Which action by the nurse is appropriate for inclusion in this session? A) Telling participants that smoking is an unacceptable behavior B) Making sure participants are aware of the increased risk of liver disease and esophageal cancer associated with smoking C) Reviewing available pharmacologic adjuncts to cessation with participants D) Recommending that participants seek hypnosis at a local dinner theater to aid in their attempts at smoking cessation
C
Which of the following characteristics would increase a client's risk of unpleasant side effects from nicotine replacement therapy (NRT)? A) Male gender B) Heavy smoking prior to beginning NRT C) Low body weight D) History of failed attempts at smoking cessation
C
The nurse is providing care to a client with a history of chronic obstructive pulmonary disease (COPD) who wants help and information regarding nicotine addiction and ways to quit smoking. After the nurse has provided education regarding smoking cessation, which client statement would indicate appropriate understanding of the information presented? 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."
C
Which of the following statements is true with regard to vaping? A) Vaping is a safe alternative to cigarette smoking. B) E-cigarettes are less popular among teenagers than cigarettes and other traditional tobacco products. C) Vaping has been linked to a devastating respiratory disease known as "popcorn lung." D) Throughout the United States, vaping is subject to the same regulations as cigarette smoking.
C
A nurse is teaching a client about the effects of smoking during pregnancy. Upon conclusion of the teaching session, which of the following client statements would suggest that further education is necessary? A) "When a pregnant woman smokes, the concentration of nicotine in the fetus can be even higher than that in the woman's own body." B) "Smoking during pregnancy is associated with an increased risk of placental problems." C) "Prenatal nicotine exposure is linked to attention deficits and learning difficulties during childhood." D) "Although women who smoke during pregnancy are at higher risk for respiratory disease later in life, their children are not."
D
A nurse who works in an outpatient primary care clinic is caring for a client with asthma who has an 80 pack-year smoking history. When assessing the client's current use of nicotine, which question is most appropriate? A) "Have you tried a nicotine patch for quitting smoking?" B) "Do you smoke cigarettes with filters or without?" C) "Do you smoke immediately after waking up?" D) "What prior attempts have you made to quit using nicotine?"
D
