addictions

A client tells the nurse, "All my friends experiment with drugs. I like the high I get when I huff paint. Nothing bad is going to happen to me." What is the best response by the nurse? "Inhalants can cause a mild state of intoxication." "Huffing paint can damage your lungs, kidneys, and liver." "Withdrawal problems will start if you continue huffing paint." "Limiting the type of inhalant used decreases respiratory irritation.

"Huffing paint can damage your lungs, kidneys, and liver."

After a visit from several friends a nurse on the mental health unit finds a client with a known history of opioid addiction in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion? Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Blood pressure of 180/100 mm Hg, tachycardia, and respiratory rate of 18 breaths/min Blood pressure of 120/80 mm Hg, regular pulse, and respiratory rate of 20 breaths/min Blood pressure of 140/90 mm Hg, irregular pulse, and respiratory rate of 28 breaths/mi

Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min

When the nurse is communicating with a client with substance-induced persisting dementia, the client cannot remember facts and fills in the gaps with imaginary information. The nurse identifies this as: Concretism Confabulation Flight of ideas Associative loosenes

Confabulation

A client has been receiving oxycodone (OxyContin) for moderate pain associated with multiple injuries sustained in a motor vehicle collision. The client has returned three times for refills of the prescription. What behavior, in addition to the client's slurred speech, leads the nurse to suspect opioid intoxication? Mood lability Hypervigilance Constricted pupils Increased respirations

Constricted pupils

While assessing an older adult client before noon the nurse smells alcohol on the man's breath. After noting certain other signs, the nurse suspects that the client is an alcoholic. What are these signs? Select all that apply. Good nutritional habits Excessive mood swings Family conflict Poor hygiene Irritability Maintenance of cognition

Excessive mood swings Family conflict Poor hygiene Irritability

A 45-year-old man who recently completed alcohol detoxification states that he plans to begin using disulfiram (Antabuse) as part of his alcoholism treatment regimen. Important client teaching by the nurse regarding this drug is that: Voluntary compliance with the Antabuse regimen is very high. A single dose of oral Antabuse will be effective for up to 72 hours. Antabuse may be taken intramuscularly and will be effective for as long as 7 days. Foods, medications, and any topical preparation containing alcohol should be avoided

Foods, medications, and any topical preparation containing alcohol should be avoided

A young adult being treated for substance abuse asks the nurse about methadone. The nurse responds that methadone is useful in the treatment of opioid addiction because it: Is a nonaddictive drug Has an effect of longer duration Does not produce a cumulative effect Carries little risk of psychological dependence

Has an effect of longer duration

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client? Constricted pupils Intractable diarrhea Increased heart rate Decreased respirations

Increased heart rate

A client is admitted to the hospital with a diagnosis of alcohol withdrawal syndrome. What body organ should the nurse teach the client will be protected by the ingestion of a high-calorie diet fortified with vitamins? Liver Heart Pancreas Adrenals

Liver

A nurse is counseling clients who are attending an alcohol rehabilitation program. Which substance poses the greatest risk of addiction for these clients? Heroin Cocaine Nicotine Marijuana

Nicotine

When talking with a client who has alcoholism, the nurse notes that the client becomes irritable, makes excuses, and blames family and friends for the drinking problem. Which defense mechanisms does the nurse conclude that the client is using? Select all that apply. Projection Suppression Sublimation Identification Rationalization

Projection Rationalization

What is a primary consideration for the nurse caring for a client with a history of substance abuse? Setting firm, consistent limits and not varying from them Using the same type of communication pattern that the client uses Avoiding upsetting the client by calling attention to the drug abuse problem Realizing that the client will probably need less pain medication than a nonabuser would

Setting firm, consistent limits and not varying from them

A nurse is caring for a client who is addicted to opioids and who has undergone major surgery. The client is receiving methadone. What is the purpose of this medication? Allows symptom-free termination of opioid addiction Switches the user from illicit opioid use to use of a legal drug Provides postoperative pain control without causing opioid dependence Counteracts the depressive effects of long-term opioid use on thoracic muscles

Switches the user from illicit opioid use to use of a legal drug

A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing the phenomenon of: Tolerance Habituation Physical addiction Psychological dependenc

Tolerance

A nurse notes that a client in the detoxification unit is exhibiting early signs of alcohol withdrawal. What clinical manifestations might the nurse have noticed? Select all that apply. Tremors Anorexia Agitation Delusions Confusion

Tremors Anorexia

A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most appropriate for the nurse to implement? Keeping the client calm by applying wrist restraints Encouraging the client to relate the content of hallucinations Assuring the client that the symptoms are part of the withdrawal syndrome Dimming the client's room lights to counter the visual distortions being experienced

Assuring the client that the symptoms are part of the withdrawal syndrome

A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply. Seizures Yawning Drowsiness Constipation Muscle aches

Yawning Muscle aches

A client in the outpatient clinic is denying that he is addicted to alcohol. He tells the nurse that he is not an alcoholic and that it is his nagging wife who causes him to drink. What is the most therapeutic response by the nurse? "I don't think that your wife is the problem." "Everyone is responsible for his own actions." "Perhaps you should have marriage counseling." "Why do you think that your wife is the cause of your problems?

"Everyone is responsible for his own actions."

A client who is experiencing acute alcohol withdrawal delirium appears frightened, points toward the bed, and says, "Bugs are crawling all over me and my bed!" What is the most therapeutic response by the nurse? "Just try to brush them off." "I don't see any bugs on you or your bed." "They'll go away when you start feeling better." "The bugs that you see are just the design on the bedspread.

"I don't see any bugs on you or your bed."

A husband is upset that his wife's alcohol withdrawal delirium has persisted for a second day. What is the most appropriate initial response by the nurse? "I see that you're worried. We're using medication to ease your wife's discomfort." "This is expected. I suggest that you go home, because there's nothing you can do to help." "Are you afraid that your wife will die? I assure you, very few alcoholics die during the detoxification process." "Are you worried that your wife is uncomfortable while she's going through withdrawal? I'm sure that she's not in pain.

"I see that you're worried. We're using medication to ease your wife's discomfort."

Oral chlordiazepoxide (Librium) 100 mg/ hr is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client has had 300 mg in 3 hours but is still displaying acute alcohol withdrawal symptoms. What is the next nursing action? Informing the client that the limit of chlordiazepoxide has been reached Administering chlordiazepoxide as indicated by the client's CIWA score Requesting a prescription for another medication to replace the chlordiazepoxide Informing the health care provider that the maximum dose of chlordiazepoxide has been reached

Administering chlordiazepoxide as indicated by the client's CIWA score

A client who is addicted to opioids undergoes emergency surgery. During the postoperative period the health care provider decreases the previously prescribed methadone dosage. For what clinical manifestations should the nurse monitor the client? Constipation and lack of interest in surroundings Agitation and attempts to escape from the hospital Skin dryness and scratching under the incision dressing Lethargy and refusal to participate in therapeutic exercises

Agitation and attempts to escape from the hospital

What is the primary reason that the nurse encourages the family of an alcoholic to become involved in the treatment program? Alcoholism involves the entire family. Alcoholics try to hide their drinking from their families. Family members provide insights into the dynamics behind the drinking. Family members have been most successful in providing necessary support

Alcoholism involves the entire family.

A 37-year-old man has been remanded by the court to the drug rehabilitation unit of a psychiatric facility for treatment of cocaine addiction. When taking his health history, what characteristics should the nurse expect the client to report? Select all that apply. Anxiety Weight loss Palpitations Sedentary habits Difficulties with speech

Anxiety Weight loss Palpitations

A nurse in charge in the surgical intensive care unit notes that a number of clients do not seem to be responding to morphine that was administered for pain. Later in the evening the nurse finds a staff nurse dozing in the nurses' lounge. When awakened, the staff nurse appears uncoordinated and drugged, with slurred speech. What should the nurse in charge do? Ask the nurse manager to be present before confronting the staff nurse. Ask other staff members whether they have noticed anything unusual lately. Tell the staff nurse that everyone now knows who has been stealing the morphine. Arrange to secretly observe the staff nurse the next time the staff nurse administers morphine.

Ask the nurse manager to be present before confronting the staff nurse.

On the third day of hospitalization, a client with a history of heavy drinking begins experiencing alcohol withdrawal delirium. What is the most appropriate response by the nurse when the client begins experiencing hallucinations? Withholding intervention, because the client may be having vivid dreams Asking the client to describe the hallucinations and explaining that they are not real Administering the prescribed medication to the client to subdue the agitated behavior Pretending to visualize the imaginary things the client is describing to foster acceptance

Asking the client to describe the hallucinations and explaining that they are not real

Alprazolam (Xanax) is prescribed for a client with the diagnosis of panic disorder. The client refuses to take the medication because he fears addiction. Initially the nurse should: Provide the client information about alprazolam. Assess the client's feelings about alprazolam further. Ask the practitioner about changing the client's Have the practitioner speak with the client about the safety of this medication.

Assess the client's feelings about alprazolam further.

A client has been taking methadone 40 mg/day for treatment of an opioid addiction. During a methadone clinic visit she tells the counselor that she is 3 months pregnant and receiving prenatal care. The counselor notifies the nurse in the prenatal clinic about the client's addiction history. What should the nurse in the prenatal clinic recommend that the client do? Withdraw the methadone slowly over the next several weeks. Continue the prescribed methadone to prevent withdrawal symptoms. Temporarily discontinue the methadone to improve maternal and neonatal outcome. Leave the methadone maintenance program during the pregnancy and reenter it after the birth

Continue the prescribed methadone to prevent withdrawal symptoms.

A client who is on the third day of detoxification therapy becomes agitated and restless. What are the signs and symptoms that indicate impending alcohol withdrawal delirium? Select all that apply. Polydipsia Drowsiness Diaphoresis Tachycardia Hypertension

Diaphoresis Tachycardia Hypertension

For what clinical manifestations should the nurse assess a client during the first few hours of the alcohol withdrawal? Select all that apply. Irritability Tachycardia Hallucinations Increasing anxiety Profuse diaphoresis

Irritability Increasing anxiety

A client with a history of chronic alcoholism is admitted to the mental health unit. What does the nurse identify as the cause of a client's use of confabulation? Ideas of grandeur Need to get attention Marked loss of memory Difficulty accepting the truth

Marked loss of memory

In addition to hydration during alcohol withdrawal delirium, parenteral administration of lorazepam (Ativan) is prescribed for a client. The nurse knows that this drug is given during detoxification primarily to: Prevent injury when seizures occur. Enable the client to sleep better during periods of agitation. Reduce the anxiety tremor state and prevent more serious withdrawal symptoms. Quiet the client and encourage cooperation by promoting acceptance of the treatment plan

Reduce the anxiety tremor state and prevent more serious withdrawal symptoms.

A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine? Risk for self-injury Potential for seizure Danger of dehydration Probability of injuring others

Risk for self-injury

When a recently hospitalized client has a tentative diagnosis of opioid addiction, the nurse should assess the client for signs and symptoms related to opioid withdrawal. List them in the order that they will occur as the client progresses through withdrawal. Runny nose Severe bone pain Flulike syndromes Return of appetite

Runny nose Return of appetite

A client with a history of chronic alcoholism was admitted to a surgical unit after surgery to repair a severely fractured right ankle. The nurse is concerned that the client is experiencing manifestations of acute alcohol withdrawal when certain documentation and assessment data from the last 6 hours seem to indicate this problem. Select all that apply. Tremors in both hands make it difficult for the client to hold a cup. The client's systolic blood pressure has dropped 6 points over last 6 hours. The client was observed falling asleep while talking on the telephone to family. The client's bed linens and pajamas had to be changed during the night as a result of increased diaphoresis. The usually cooperative client becomes verbally abusive when asked to lower the volume of the television

Tremors in both hands make it difficult for the client to hold a cup The client's bed linens and pajamas had to be changed during the night as a result of increased diaphoresis. The usually cooperative client becomes verbally abusive when asked to lower the volume of the television

A client who is homeless is hospitalized for alcohol withdrawal. When considering the type of personal protective equipment that is needed for the client's care, the nurse recalls that homeless persons are at risk for: Prostatitis Tuberculosis Osteoarthritis Diverticulosis

Tuberculosis

A nurse is in the process of developing a therapeutic relationship with a client who has an addiction problem. What client communication permits the nurse to conclude that they are making progress in the working stage of the relationship? Select all that apply. Describes how others have caused the addiction Verbalizes difficulty identifying personal strengths Expresses uncertainty about meeting with the nurse Acknowledges the effects of the addiction on the family Addresses how the addiction has contributed to family distress

Verbalizes difficulty identifying personal strengths Acknowledges the effects of the addiction on the family Addresses how the addiction has contributed to family distress