CH 58 Drugs for Substance Use Disorders
A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for proprandol (Inderol). Which of the following information should the nurse include in the teaching? A) Increases the risk for seizure activity B) Provides a form of aversion therapy C) Decreases cravings D) Can increase blood pressure
C) Decreases cravings
The nurse who is caring for a patient who has been abusing alcohol may expect to see what symptom as the patient enters withdrawal? A) sleep B) muscle relaxation C) euphoria D) agitation
D) agitation
The nurse is caring for a client suspected of ketamine abuse. What characteristic behavior would the nurse expect to observe? increased physical strength sensory hallucinations catatonia euphoria
sensory hallucinations Explanation: Ketamine is a general anesthetic that is chemically related to PCP and used during induction or maintenance of general anesthesia. Ketamine causes distorted senses and perceptions as well as dissociative reactions. These effects produce a high risk of injuries. Abnormal strength, euphoria, and catatonia are not characteristic effects of this medication.
What symptoms should the nurse assess for when caring for a hospitalized client with a long history of alcohol abuse? A) confusion, hallucination, agitation, and tremors B) denial, manipulation, and combativeness C) depression, remorse, and withdrawal from reality D) suspicion, mania, stubbornness, and fear
A) confusion, hallucination, agitation, and tremors
A client with a well-known history of heroin use has begun addiction treatment. The nurse had administered the client's daily dose of methadone (Dolphine). How does methadone therapy affect opioid addiction? A) acts as an agonist at opioid receptors and prevents withdrawal symptoms B) acts as an opioid antagonist and causes unpleasant symptoms if the client uses opioids C) acts on the limbic system and the reticular system to suppress brain activity associated with addiction D) acts to depress the central nervous system (CNS) to a similar degree as opioids, aiding in detoxification
A. Acts as an agonist at opioid receptors and prevents withdrawal symptoms Feedback: Methadone is an agonist at specific opioid receptors in the CNS. Its action allows it to prevent symptoms of withdrawal. It does not cause unpleasant effects if the patient uses opioids and does not act directly on the limbic system or reticular system.
A charge nurse is planning a staff education session to discuss medications used during the care of a client experiencing alcohol withdrawal. Which of the following medications should the charge nurse include in the discussion? SELECT ALL THAT APPLY. A) Lorazepam (Ativan) B) Diazepam (Valium) C) Disulfiram (Antabuse) D) Naltrexone (Narcan) E) Acamprosate (Campral)
A) Lorazepam (Ativan) B) Diazepam (Valium)
A client who uses cocaine finally admits other drugs were also abused to equalize the effect of cocaine. Which substance might be included in the client's pattern of polysubstance abuse? Alcohol Amphetamines Caffeine Phencyclidine
Alcohol Explanation: A cocaine addict will usually use alcohol to decrease or equalize the stimulating effects of cocaine. Amphetamines, caffeine, and phencyclidine aren't used to equalize the stimulating effects of cocaine.
A teenager is taking a central nervous system (CNS) stimulant. Which of the following is a common effect of CNS stimulant medications? A) hypotension B) anorexia C) sedation D) hypouricemia
B) anorexia
A patient is admitted to the chemical dependence unit. The nurse receives an order to administer flumazenil (Mazicon). Clinicians use flumazenil to treat overdoses with which of the following? A) alcohol B) benzodiazepines C) opioids D) amphetamines
B) benzodiazepines
A nurse is providing health education for the family of a patient who has a substance use disorder. How should the nurse best explain the etiology of this disorder? A. "Substance abuse is a complex phenomenon, and science has not yet begun to truly understand the phenomenon." B. "Substance abuse is multifactorial and involves genetics, personality, and culture." C. "Many different factors contribute to substance abuse, but the primary ones are lack of willpower and impaired coping." D. "Substance abuse is considered to be primarily a cultural concept, since definitions vary widely across time and place."
B. "Substance abuse is multifactorial and involves genetics, personality, and culture." Feedback: Researchers have identified a number of factors in the predisposition to substance abuse and dependence. These factors include genetics, personality, and culture. The disorder is not, however, solely rooted in culture or wholly misunderstood. It is simplistic to understand the disorder as resulting from impaired coping and lack of willpower.
A patient is being treated for opioid abuse after many years of cocaine and heroin use. The nurse should anticipate that this patient will be treated with what drug? A. Naloxone (Narcan) B. Methadone (Dolophine) C. Flumazenil (Romazicon) D. Disulfiram (Antabuse)
B. Methadone (Dolophine) Feedback: Opioid withdrawal symptoms are treated with methadone. Naloxone is used to treat acute opioid intoxication or overdose, but it is not used to treat opioid abuse.
A construction worker sees the company's occupational health nurse. He inquires about smoking cessation medications. Which of the following drug products can be used to aid smoking cessation? A) naltrexone (Narcan) B) disulfiram (Antabuse) C) bupropion (Wellbutrin) D) dronabinol (cannibis)
C) bupropion (Wellbutrin)
A nurse in an acute mental health facility is caring for a client who is experiencing withdrawal from opioid use and has a new prescription for clonidine (Catapres). Which of the following actions should the nurse identify as the priority? A) Administer the clonidine on the prescribed schedule. B) Provide ice chips at the client's bedside. C) Educate the client on the effects of clonidine. D) Obtain baseline vital signs.
D) Obtain baseline vital signs.
A 15-year-old boy with a complex psychosocial history is being treated for inhalant abuse. When providing health education to a client being treated for inhalant abuse, the nurse should focus on which associated risk? SELECT ALL THAT APPLY. A) extreme hyperactivity B) psychological dependence C) physiological dependence D) organ damage E) impaired brain development
D) organ damage E) impaired brain development Feedback: Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Dependence has not been definitively demonstrated, and hyperactivity is not a risk.
A client has lived with alcohol addiction for many years, and has relapsed after each attempt to stop drinking. The client has now been prescribed disulfiram. What education should the nurse provide to the client? Drinking even small amounts of alcohol will cause illness. This medication will eliminate cravings for alcohol. The medication prevents the client from experiencing any effects of alcohol intake. A dose should be taken promptly if the client drinks alcohol.
Drinking even small amounts of alcohol will cause illness. Explanation: The combination of disulfiram with alcohol may result in headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. The medication does not directly eliminate cravings and it must not be taken within 12 hours of drinking alcohol.
There are several reasons why drug therapy is of limited use in treating substance dependence. Which of the following statements accurately describes a potentially serious risk of such therapy? The patient may not want to undergo drug therapy. The therapy is usually ineffective. The wide range of antidotes makes selection of the appropriate treatment drug difficult. Drug therapy could substitute one abused drug for another.
Drug therapy could substitute one abused drug for another. Explanation: One of the main limitations in using drug therapy to treat dependence is the high risk of substituting one abused drug for another. A second limitation is that specific antidotes are available only for benzodiazepines and opioid narcotics.
A patient was at a party and thinks someone "slipped something into my drink." She says she has little to no memory of what occurred after a man asked her to dance; when she became aware of her surroundings, she was home and undressed. What drug does the nurse suspect this patient may have ingested? Flunitrazepam (Rohypnol) Cocaine Methamphetamine Chlordiazepoxide (Librium)
Flunitrazepam (Rohypnol) Rohypnol is also known as the "date rape" drug and can cause confusion, fatigue, memory loss for the time under the drug's effects, impaired coordination/memory/judgment, visual/gastrointestinal disturbances, and urinary retention.
A patient arrives at the emergency department accompanied by a friend. The friend states that the patient was found stumbling and vomiting, with slurred speech. The nurse observes sores around the patient's mouth and a chemical odor of the breath. What does the nurse suspect the patient has been using? Anabolic androgenic steroids Inhalants Designer drugs Alcohol
Inhalants Explanation: The nurse should suspect inhalant abuse when observing paint or stains on the body or clothing, spots or sores around the mouth, red or runny eyes and nose, chemical odor on the breath, a drunken or dazed appearance, loss of appetite, excitability, and irritability.
You are the nurse caring for a patient with a history of substance abuse. What would be an appropriate initial goal for this patient? Lifelong abstinence from the abused substance Lack of adverse effects from substance abuse Longer periods of abstinence and sobriety There is no definite goal of treatment for substance abuse.
Longer periods of abstinence and sobriety Explanation: Recovery is life-long and requires total abstinence from the abused substance. The recovering person can never return to controlled use without rekindling the addiction. Hence, a realistic goal of treatment would be to achieve longer and longer periods of abstinence and sobriety. This goal needs to be emphasized during ongoing assessment and evaluation. Relapse prevention includes teaching patients to identify and manage feelings, recognize high-risk situations, and develop effective coping strategies.
When questioned about her alcohol usage, a female client states that she drinks three martinis a night. What assessment should the nurse make of this statement? This is the correct amount consumed. She normally consumes four to six martinis a night. She is giving information she expects the nurse expects to hear. She may have understated the amount of alcohol consumed.
She may have understated the amount of alcohol consumed. Explanation: Abusers of alcohol and other drugs are not reliable sources of information about the types or amounts of drugs used. Most abusers understate the amount and frequency of substance use.
A nurse has admitted a client diagnosed with substance abuse intoxication to the unit. The nursing assessment will first be directed toward data regarding: genetic factors. the client's perception of the admitting problem. drug use. family history of substance abuse.
drug use. Explanation: Substance dependence denotes a maladaptive pattern of use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the resulting negative effects.
A nurse is instructing a client who's to receive disulfiram (Antabuse). Which statement by the client demonstrates that the teaching was effective? "I can use any aftershave." "I can use any mouthwash." "I can use any cough syrups." "I can use any antacids."
"I can use any antacids." Explanation: Antacids don't interact with disulfiram. The client should avoid anything containing alcohol, including aftershave lotion and some cough medicines and mouthwashes.
The hospital nurse is responding to a code blue where a client is believed to have overdosed on an unknown opioid. The team administered naloxone 2 mg IV to the client 2 minutes ago with no appreciable improvement in respiratory function or level of consciousness. What is the nurse's most appropriate action? Anticipate the immediate administration of another dose of naloxone. Reposition the client and monitor closely for 2 more minutes. Prepare naloxone 10 mg IV for administration as soon as prescribed. Prepare epinephrine IV for administration as soon as prescribed.
Anticipate the immediate administration of another dose of naloxone. Explanation: If therapeutic effect is not achieved with an initial dose of naloxone, it may be administered at 2-3 minute intervals. However, subsequent doses would be similar in quantity to the initial dose, not 10 mg. Epinephrine will not mitigate the effects of an opioid overdose. Repositioning and monitoring would be insufficient responses, since the client requires an opioid antagonist to resume respiratory function.
A nurse is teaching a client who has a new prescription for clonidine (Catapres) to assist with maintenance of abstinence from opioids. The nurse should instruct the client to monitor for which of the following adverse effects? A) Diarrhea B) Dry mouth C) Insomnia D) Hypertension
B) Dry mouth
Which of the following medications is the health care provider most likely to prescribe for a patient who is experiencing alcohol withdrawal? A) haloperidol (Haldol) B) chlordiazepoxide (Librium) C) propoxyphene D) phenytoin (Dilantin)
B) chlordiazepoxide (Librium)
A patient is taking disulfiram (Antabuse) and later consumes several shots of vodka. What effect will be produced from the combination of alcohol and disulfiram? A) hypertension B) vomiting C) hyperalertness D) oral bleeding
B. Vomiting Feedback: Disulfiram interferes with hepatic metabolism of alcohol and allows the accumulation of acetaldehyde. If alcohol is ingested during disulfiram therapy, acetaldehyde causes headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. Disulfiram will not cause hypertension, increased alertness, or bleeding.
The triage nurse in the emergency department admits a client in distress. The client's parents attribute the client's distress to amphetamine use. What assessment finding would best corroborate this parent's suspicion? Blood pressure 196/117 mm Hg Heart rate 96 beats/min, regular rhythm Drowsiness, arousable by touch Dilated pupils, unresponsive to light
Blood pressure 196/117 mm Hg Explanation: Increases in blood pressure, tachycardia, insomnia, and restlessness are symptoms of amphetamine abuse. Pupil response is not normally affected by amphetamines, unlike narcotics. The client is more likely to be agitated than drowsy.
The nurse should plan care with the goal of preventing which primary signs of alcohol withdrawal? A) bradycardia B) hypotension C) delirium tremens D) gastrointestinal bleeding
C) delirium tremens
A patient is admitted to the chemical dependence unit with chronic alcohol abuse. For which of the following symptoms does the nurse assess during alcohol withdrawal? A) euphoria, hyperactivity, and insomnia B) depression, suicidal ideation, and hypersomnia C) diaphoresis, nausea, vomiting, and tremors D) unsteady gait, nystagmus, and profound disorientation
C) diaphoresis, nausea, vomiting, and tremors
The nurse who is caring for a patient admitted with an acute overdose of cocaine. What physiologic response should the nurse expect? A) severe lung damage B) anaphylaxis C) myocardial infarction D) hypotension
C) myocardial infarction
A client is admitted to an alcohol rehabilitation program. What medication will the client most likely be prescribed to treat alcohol withdrawal syndromes? A) clonidine (Catapres) B) methyldopa (Aldomet) C) chlordiazepoxide (Librium) D) atenolol (Tenormin)
C. Chlordiazepoxide (Librium) Feedback: Benzodiazepines antianxiety agents are the drugs of choice for treating alcohol withdrawal syndromes. Chlordiazepoxide is administered to patients for acute withdrawal syndrome. Clonidine is not a benzodiazepine and is not prescribed for acute alcohol syndrome. Methyldopa is not a benzodiazepine and is not prescribed for acute alcohol syndrome. Atenolol is not a benzodiazepine and is not prescribed for acute alcohol syndrome.
The neonatal nurse is providing care for an infant whose medication regimen includes methadone 1.5 mg/kgPO q12h. What desired outcome should the nurse most likely include in the infant's plan of care? Client will remain free of signs of opioid withdrawal. Client will remain free of signs and symptoms of pain. Client will require less than 0.05 mg/kg morphine for pain control. Client's vital signs will remain within reference ranges.
Client will remain free of signs of opioid withdrawal. Explanation: Methadone can be used to treat neonatal opioid withdrawal syndrome. An absence of the associated signs and symptoms would be considered a desired outcome of this treatment. Assessment would include vital signs but would also go further to include the varied signs and symptoms of withdrawal. Methadone is not normally used for pain control in infants and would not be used to complement morphine.
An adult client has a long history of alcohol abuse and has been through many cycles of attempted recovery followed by relapse. The client's health care provider has prescribed naltrexone to the interdisciplinary care plan. What desired outcome should the nurse document in the client's care plan on the basis of this new prescription? Client will report reduced cravings for alcohol consumption. Client will experience unpleasant physiologic effects after consuming alcohol. Client will report an absence of euphoria after consuming alcohol. Client will not exhibit CNS depression after drinking alcohol.
Client will report reduced cravings for alcohol consumption. Explanation: Naltrexone is shown to reduce alcohol cravings in some clients. It does not produce physiologic effects such as illness after alcohol use, mitigation of CNS depression, or absence of euphoria if the client happens to consume alcohol.
A patient was admitted with a diagnosis of a gastrointestinal bleed, the latest of several hospital admissions that have been attributed to his alcohol abuse. The addictions medicine specialist has prescribed disulfiram, which will A. prevent the patient from experiencing euphoria if he drinks alcohol. B. intensify the patient's CNS depression if he drinks alcohol. C. result in a depressed mood if he drinks alcohol. D. produce unpleasant reactions if the patient drinks alcohol.
D. produce unpleasant reactions if the patient drinks alcohol. Feedback: Disulfiram inhibits the enzyme aldehyde dehydrogenase to block the oxidation of alcohol. The resulting accumulation of acetaldehyde produces an unpleasant reaction when disulfiram is consumed with alcohol. The effects do not include prevention of euphoria, increased CNS depression, or depressed mood, however.
As an adjunct to a client's alcohol withdrawal management program, the health care provider orders disulfiram. The nurse is responsible for the client's education program. When the client arrives home after discharge, the client pours a beer. What symptoms would the client expect to experience? (Select all that apply.) Flushing, tachycardia, and garlic aftertaste Hypotension, anemia, and confusion Sweating, nausea, and vomiting Paranoia, mania, and depression Blurred vision, headache, and chest pain
Flushing, tachycardia, and garlic aftertaste Sweating, nausea, and vomiting Blurred vision, headache, and chest pain The combination of disulfiram with alcohol may result in headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. More severe effects with alcohol) include arrhythmias, cardiovascular collapse, heart failure, myocardial infarction, and death.
A female client presents to the emergency department confused and disheveled and states that she was raped. She attended a party earlier in the evening. What substance, often called a date rape drug, might have been added to her drink? THC Cocaine Ketamine GHB
GHB Explanation: Usage of GHB has increased in recent years, mainly in the party or dance-club setting, and GHB is increasingly involved in poisonings, overdoses, date rapes, visits to hospital emergency departments, and fatalities.
A male client returns to the psychiatric unit after being on a 6-hour pass. The nurse observes that the client is agitated and ataxic and that he exhibits nystagmus and general muscle hypertonicity. The nurse suspects that the client was using drugs while away from the unit. His symptoms are most indicative of intoxication with which drug? Phencyclidine (PCP) Crack cocaine Heroin Cannabis
Phencyclidine (PCP) Explanation: The client's behavior suggests the use of PCP. Crack cocaine intoxication is characterized by euphoria, grandiosity, aggressiveness, paranoia, and depression. Heroin intoxication is characterized by euphoria followed by sleepiness. Cannabis intoxication is characterized by a panic state and visual hallucinations.
A client reports that, "The alcohol treatment programs I've tried in the past have only helped for a little and then I start drinking again." This statement best describes which type of alcohol-related behavior? Psychological dependence Physical dependence Tolerance Withdrawal
Psychological dependence Explanation: The client is describing psychological dependence which involve feelings of satisfaction and pleasure from taking a drug. These feelings of dependence return the client to drug-taking behavior after periods of abstinence. Physical dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating a person continues to use a substance of abuse despite significant substance-related problems. Tolerance is the need for increasingly larger or more frequent doses of a substance to obtain the desired effects originally produced by a lower dose. Withdrawal is development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitant due to the cessation of or reduction in heavy and prolonged substance use.
A client was prescribed oral hydromorphone two weeks ago for the treatment of cancer pain. The client was able to achieve pain relief with 2 mg doses for the first 10 days, but has recently needed 3-4 mg to achieve the same effect. The client has expressed concern to the nurse that he is becoming addicted to hydromorphone. What should the nurse teach the client? The client is developing a tolerance, which is not the same as addiction. The client is likely developing a psychological dependence on morphine. There are interventions available to treat early addiction. The client will not become addicted because the medication has a legitimate use.
The client is developing a tolerance, which is not the same as addiction. Explanation: Tolerance is characterized by needing larger doses of a medication to achieve the effect that lower doses produced in the past. The client has not described the feelings of satisfaction and euphoria that characterize psychological dependence. Even though the client is taking this medication for legitimate reasons, this does not mean that addiction is not possible. There are indeed interventions to address addiction, but this is not a necessary teaching point at this time because there are no obvious signs of addiction.
A family expresses concern when a family member withdrawing from alcohol is given lorazepam (Ativan). What information should be given to the family about the medication? The medication promotes a sense of wellbeing during the client's difficult withdrawal period The medication is given for a short time to help the client complete the withdrawal process The medication will help the client forget about the physical sensations that accompany alcohol withdrawal The medication helps in the treatment of coexisting diseases, such as cardiac problems and hypertension
The medication is given for a short time to help the client complete the withdrawal process Explanation: Lorazepam is a short-acting benzodiazepine that may be given for 1 week to help the client in alcohol withdrawal. However, there's some debate over its use due to a potential risk for cross-addiction. The medication isn't given to help forget the experience; it lessens the symptoms of withdrawal. It isn't used to treat coexisting cardiovascular problems or promote a sense of well-being.
The nurse is caring for a client for whom a psychological therapy has been ordered to assist with recovery from an addictive disorder. The nurse understands that what statement is true about psychological rehabilitation efforts? They do not make an impact on addiction treatment because it is a physical dependence. They should be part of any treatment program for a drug-dependent person. They are rarely covered by health insurance. They are successful when used in facility-based rehabilitation programs.
They should be part of any treatment program for a drug-dependent person. Explanation: Psychological rehabilitation efforts should be part of any treatment program for a drug-dependent person.
The nurse is taking a health history from a patient in the clinic and asks about the use of alcohol. The patient states that he drinks approximately a case of beer on some weekends. What does the nurse understand about this type of substance use? This patient abuses alcohol on weekends; this is considered substance abuse. This patient is addicted to alcohol and will have withdrawal symptoms if he does not have the alcohol. This patient has a cross dependence and most likely abuses other substances. This patient has developed a tolerance to alcohol and needs more to become intoxicated.
This patient abuses alcohol on weekends; this is considered substance abuse. Explanation: Substance abuse is the inappropriate and usually excessive self-administration of a drug substance for nonmedical purposes.
Charlie, a homeless heroin addict, has been admitted into care and needs immediate intervention. A visiting health care provider has begun Charlie on methadone maintenance. What fact should the nurse consider during this client's treatment for substance use? Methadone is an ineffective drug. Using methadone maintenance may lead to a dependence on methadone. Methadone has a short duration of action. Methadone is expected to be soon banned in the United States.
Using methadone maintenance may lead to a dependence on methadone. Explanation: Methadone is an opioid with a dependence-producing liability. Although oral methadone dosing suppresses opioid withdrawal symptoms and the drug has a long duration of action, there is a risk of the client developing a dependence on methadone.
A client admits to smoking marijuana several times a day but denies being dependent on the drug. The nurse should base the discussion with the client on what characteristic of psychological dependence? Using the drug creates the feeling of satisfaction and pleasure. Stopping the drug results in unpleasant symptoms. Laboratory findings are congruent with frequent intoxication. There is a need to increase frequency of medication usage to achieve desired effects.
Using the drug creates the feeling of satisfaction and pleasure. Explanation: Psychological dependence involves feelings of satisfaction and pleasure from taking the drug. These feelings, perceived as extremely desirable by the drug-dependent person, contribute to acute intoxication, development and maintenance of drug abuse patterns, and return to drug-taking behavior after periods of abstinence. Physical dependence results in unpleasant symptoms when the drug is stopped. Laboratory findings congruent with frequent intoxication would be further evidence of physical dependence. Tolerance is the need to increase drug usage to obtain the desire effect. The other options are also related directly to physiologic dependency.
While the school nurse is providing health education to a group of children on the dangers of illicit drug use, a child asks the nurse what sniffing gasoline or glue does to the body. What response is most effective in addressing this question? "Doing that damages the brain and other body organs." "It depends on what a person sniffs and how often they do it." "The most serious effects are the damage to the nostrils and sinuses." "Let's talk about why you would want to sniff these substances."
"Doing that damages the brain and other body organs." Explanation: Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Comparatively, damage to the nose is less significant. Damage is dose dependent, but it would be most appropriate to address possible areas of harm. While exploring the reasons behind the activity is appropriate, it does not address the question.
A client with a history of alcohol abuse has responded well to a treatment plan that includes a support group, psychological counseling, vitamin supplements, and disulfiram 450 mg PO daily. The client has presented to the emergency department with confusion, vomiting, and blood pressure of 89/57 mm Hg. What is the nurse's best assessment question? "When did you last have a drink of alcohol?" "When did you take your last dose of disulfiram?" "Have you been complying with your treatment plan?" "How would you rate your discomfort, between 0 and 10?"
"When did you last have a drink of alcohol?" Explanation: The client's symptoms are very likely the result of alcohol intake, and the nurse's question should focus directly and unequivocally on this factor. Asking about general "compliance" with treatment is a less direct method of identifying this important assessment data. Deviations from the prescribed regimen of disulfiram would not cause these symptoms in the absence of alcohol intake. The client's level of discomfort is a relevant assessment, but the priority would be the client's alcohol intake, which has a direct effect on his or her current presentation.
A client has been deemed a candidate for methadone therapy. What instruction should the nurse provide when preparing the client for this treatment plan? "For the first few weeks, you'll need to come to the outpatient clinic for an intravenous (IV) dose of methadone." "You can take your methadone pills at any time, but it's important that it be on an empty stomach." "You'll need to come to the clinic to get your daily dose of methadone." "The doctor will prescribe 1 weeks' worth of methadone at a time."
"You'll need to come to the clinic to get your daily dose of methadone." Explanation: Methadone is usually given in a single, daily oral dose at an outpatient methadone clinic. Neither IV dosing nor food restrictions are required. Dosing is provided on a daily basis to avoid abuse behaviors.
A nurse is teaching a client who has tobacco use disorder about nicotine replacement therapy. Which of the following statements by the client indicates understanding of the teaching? A) "I should avoid eating right before I chew a piece of nicotine gum." B) "I will need to stop using the nicotine gum after 1 year." C) "I know that nicotine gum is a safe alternative to smoking if I become pregnant." D) "I must chew the nicotine gum quickly for about 15 minutes."
A) "I should avoid eating right before I chew a piece of nicotine gum."
A client is prescribed disulfiram (Antabuse). How does this medication assist the client in refraining from ingestion of alcohol? A) allows the accumulation of acetaldehyde B) increases the level of serotonin C) increases the level of acetylcholine D) decreases stimulation of the central nervous system (CNS)
A. Allows the accumulation of acetaldehyde Feedback: Disulfiram interferes with hepatic metabolism of alcohol and allows accumulation of acetaldehyde. Disulfiram does not increase the level of serotonin. Disulfiram does not increase the level of acetylcholine. Disulfiram does not decrease the stimulation of the central nervous system.
A patient has a long history of heavy alcohol use and has been admitted to the hospital for traumatic injuries after a motor vehicle accident. How should the nurse best assess the patient for physical dependence on alcohol? A. Assess the patient for signs and symptoms of alcohol withdrawal. B. Assess the patient's typical alcohol intake. C. Assess the patient's perceptions of his coping strategies. D. Assess whether the patient ever feels guilty about his drinking.
A. Assess the patient for signs and symptoms of alcohol withdrawal. Feedback: Physical dependence involves physiologic adaptation to chronic use of a drug so that withdrawal, or unpleasant symptoms, occurs when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Assessment of coping strategies, alcohol intake, and the patient's feelings about his drinking are relevant, but none directly addresses the possibility of physical dependence.
A patient is admitted to the hospital for treatment of a stasis ulcer of the right leg. The patient's history indicates he has abused alcohol in the past, and he typically consumes at least eight alcoholic beverages daily. What symptoms should the nurse assess the patient for? A. Confusion, hallucination, agitation, tremors B. Denial, manipulation, combativeness C. Suspicion, mania, stubbornness, fear D. Depression, remorse, withdrawal from reality
A. Confusion, hallucination, agitation, tremors Feedback: Delirium tremens, the most serious form of alcohol withdrawal, is characterized by confusion, disorientation, delusions, visual hallucinations, and other signs of acute psychosis. Denial, manipulation, combativeness, depression, remorse, withdrawal from reality, suspicion, mania, stubbornness, and fear are not symptoms of alcohol withdrawal.
A patient was admitted to the emergency room with acute alcohol intoxication and has been diagnosed with alcohol abuse after subsequent assessment and treatment. What are the goals of long-term treatment of this patient's substance abuse disorder? A) detoxification, abstinence, and prevention of relapse B) withdrawal, reeducation, and compliance C) withdrawal, abstinence, and accountability D) assessment, planning, and intervention
A. Detoxification, abstinence, and prevention of relapse Feedback: The major goals of treatment for substance abuse are detoxification, initiation of abstinence, and prevention of relapse. Withdrawal may occur, but this is not a goal of treatment. The nursing process may be utilized, but the steps of the process are not the goals of treatment.
A patient is admitted to the emergency room suffering from symptoms of alcohol withdrawal. The nurse should plan care with the goal of preventing which of the following? A. Seizures B. Hypotension C. Gastrointestinal bleeding D. Bradycardia
A. Seizures Feedback: In acute alcohol withdrawal, a goal of treatment is to prevent seizures. Bradycardia is not the primary symptom of acute alcohol withdrawal. Hypotension is not the primary symptom of acute alcohol withdrawal. Gastrointestinal bleeding results from heavy alcohol use but is not the primary symptom of acute alcohol withdrawal.
A nurse working in the emergency department is caring for a patient who has been brought in with suspected opioid overdose. What is the appropriate treatment to administer? A) disulfiram (Antabuse) B) naloxone (Narcan) C) amitriptyline (Elavil) D) chlordiazepoxide (Librium)
B) naloxone (Narcan)
What is the expected results of disulfiram (Antabuse) therapy if a client consumes alcohol? A) minimal euphoria B) unpleasant physical reactions C) increased central nervous system (CNS) depression D) depressed mood
B) unpleasant physical reactions
What is the most common cause of death from opioids? A) hypertension B) central nervous system stimulation C) respiratory depression D) myocardial infarction
C) respiratory depression
A 77-year-old patient is admitted for the treatment of a fracture, and the nurse has identified that the patient has a history of heavy alcohol use. At what point should the care team administer pharmacologic treatments for alcohol withdrawal? A. After cognitive behavioral therapy has begun B. After skeletal muscle relaxants have taken effect C. As soon as the patient shows signs of withdrawal D. After treatment for the patient's acute injuries has been completed
C. As soon as the patient shows signs of withdrawal Feedback: Treatment with chlordiazepoxide for alcohol withdrawal should begin as soon as the clinician identifies that the patient needs it. It is unsafe to delay treatment of withdrawal. Muscle relaxants are not indicated in the treatment of alcohol withdrawal.
A 33-year-old patient with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an inpatient basis. When a nurse is administering this medication, he or she should do which of the following actions? A. Administer the oral form of the medication if the patient is combative B. Promptly stop administering the medication once status improvements are noted C. Monitor the patient's vital signs closely during IV administration D. Assess the patient's cardiac status prior to administering each dose
C. Monitor the patient's vital signs closely during IV administration Feedback: The nurse should take the patient's vital signs regularly when giving the IV form of this drug, as well as observe and document subjective and objective reports by the patient. Combative patients usually require a parenteral route of administration, and it is unnecessary to perform a full cardiac assessment before each dose. Usage should be tapered, and not stopped abruptly, in order to prevent rebound CNS stimulation.
A patient with a diagnosis of endocarditis has been admitted, and the care team is aware that IV opioid use is the origin of the patient's infection. The patient is open to the idea of treatment for her substance abuse disorder. When planning this aspect of the patient's care, what goal should the nurse first address? A. Compliance with treatment B. Taking ownership of the problem C. Safe detoxification D. Adequate stimulation of the CNS
C. Safe detoxification Feedback: The major goals of treatment for substance abuse are detoxification, initiation of abstinence, and prevention of relapse. Ensuring the patient's safety during detoxification is a priority over compliance with treatment. Taking ownership and providing CNS stimulation are not priority goals.
A man has asked the care team to consider the use of benzodiazepines to treat his wife's severe alcoholism. The use of benzodiazepines for this purpose may be contraindicated in what circumstances? A. The patient is also addicted to nicotine. B. The patient has previously been treated with benzodiazepines. C. The patient is acutely intoxicated. D. The patient denies the severity of her addiction.
C. The patient is acutely intoxicated. Feedback: If the patient's vital signs are depressed during acute intoxication, the use of benzodiazepines is contraindicated. Denial, previous treatment with benzodiazepines, and nicotine addiction do not contraindicate this treatment.
A patient is being treated for addiction to cocaine and heroin and will begin treatment with naltrexone (ReVia). If the patient uses an opioid after taking this drug, the nurse should expect what effect? A. The patient will experience a decline in neurological function. B. The patient will experience visual disturbances and unpleasant hallucinations. C. The patient will not experience the usual physiological effects of opioids. D. The patient will experience a sudden onset of nausea and vomiting.
C. The patient will not experience the usual physiological effects of opioids. Feedback: Naltrexone (ReVia) is a pure opioid antagonist that blocks opioids from occupying receptor sites, thereby preventing their physiologic effects. It will not cause neurological deficits, GI upset, or hallucinations.
A client has been prescribed both disulfiram (Antabuse) and phenytoin (Dilantin) . Based on the interaction of these two medications, the nurse should suggest what adjustment to the medication therapies? A) more frequent administration of disulfiram B) a larger dose of disulfiram C) a reduced dose of phenytoin D) phenytoin to be administered twice daily
C. The patient will require a reduced dose of phenytoin (Dilantin). Feedback: The patient will require a reduced dose of phenytoin (Dilantin) because disulfiram interferes with the metabolism of phenytoin. The patient will not require more frequent administration of disulfiram. The patient will not require a larger dose of disulfiram. The patient will not require increased administration of phenytoin.
A patient has been brought to the emergency department by paramedics. The patient's known history and highly agitated state are suggestive of cocaine-induced psychosis. What assessment should the nurse prioritize prior to administering pharmacologic treatments? A) assessment of blood glucose levels B) assessment of cranial nerve function C) lung auscultation D) cardiovascular assessment
D. Cardiovascular assessment Feedback: Cocaine intoxication carries a high risk for cardiac dysrhythmias. Consequently, cardiovascular assessment would be a priority over lung auscultation, assessment of cranial nerve function, or assessment of blood glucose levels.
A 22-year-old male is brought to the emergency room due to an overdose of diazepam (Valium). What drug will be administered in the emergency room to treat the overdose? A. Methadone (Dolophine) B. Naloxone (Narcan) C. Disulfiram (Antabuse) D. Flumazenil (Romazicon)
D. Flumazenil (Romazicon) Feedback: Flumazenil (Romazicon) is a specific antidote that can reverse benzodiazepine-induced sedation, coma, and respiratory depression. Disulfiram is not administered to reverse benzodiazepine overdose. Methadone is not administered to reverse benzodiazepine overdose. Naloxone is not administered for benzodiazepine overdose.
A woman comes to the emergency department reporting that she thinks she was date raped. She states that she cannot remember anything and is extremely sleepy. "I think someone put something in my drink." What drug should the nurse suspect was most likely to be put in her drink? Gamma hydroxybutyrate Ketamine MDA Heroin
Gamma hydroxybutyrate Explanation: Gamma hydroxybutyrate (GHB) causes memory loss and somnolence and is commonly used as a date rape drug. Ketamine causes disorientation and loss of sensation, but not memory loss. MDA or ecstasy causes loss of memory and hallucinations, but not memory loss. It is not commonly used as a date rape drug. Heroin does not cause amnesia and is not commonly used as a date rape drug.
Which major cardiovascular problem may occur in a client with chronic alcoholism? Arteriosclerosis Heart failure Heart valve damage Pericarditis
Heart failure Explanation: Heart failure is a severe cardiac consequence associated with long-term alcohol use. Arteriosclerosis, heart valve damage, and pericarditis aren't medical consequences of alcoholism.
Which of the following medication is a narcotic antagonist? Oxycodone (Oxycontin) Naloxone (Narcan) Methadone (Dolophine) Clonidine (Catapres)
Naloxone (Narcan) Explanation: Narcan is a narcotic antagonist. Dolophine is a synthetic narcotic. Catapres is a alpha-adrenergic blocker. Oxycontin is a opiate drug.
A 19-year-old male client arrives at the emergency department with his friend. His friend states that they were smoking marijuana and the client suddenly began having hallucinations, began exhibiting bizarre behavior, and then became unconscious. The nurse finds that the client is hypertensive and suspects that the marijuana was laced with what substance? Ketamine GHB THC PCP
PCP Explanation: Phencyclidine (PCP) produces excitement, delirium, hallucinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired thought processes; impaired motor skills; psychotic reactions; sedation and analgesia; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death. Death from overdose also has occurred as a result of respiratory depression. Bizarre murders, suicides, and self-mutilations have been attributed to the schizophrenic reaction induced by PCP, especially in high doses. The drug also produces flashbacks.
The nurse has been trying to help a client wean off strong pain medication but the client keeps complaining the new drug is not working. The nurse would suspect this client is exhibiting which type of behavior? Tolerance Intoxication Physical dependence Psychological dependence
Physical dependence Explanation: The client is demostrating physical dependence to a drug. Physical dependence is a cluster of cognitive, behavioral, and physiological symptoms, indicating a person continues to use a substance of abuse despite significant substance-related problems. Psychological dependence which involve feelings of satisfaction and pleasure from taking a drug. These feelings of dependence return the client to drug-taking behavior after periods of abstinence. Tolerance is the need for increasingly larger or more frequent doses of a substance to obtain the desired effects originally produced by a lower dose. Intoxication is symptoms caused by recent ingestion of a substance.
During his assessment, Drew reveals that he is a frequent user of crack and has been on a binge for several days. The nurse realizes that he requires frequent cardiac assessments. The reason for this increased assessment of the cardiac system is because of the major risk for what condition as a result of crack cocaine use? Nasal mucosal atrophy Hepatotoxicity Rupture of the aorta Renal ischemia
Rupture of the aorta Explanation: While nasal mucosal atrophy, hepatotoxicity, and renal ischemia are common adverse effects of cocaine, a person using crack faces an additional, usually fatal risk of sudden death due to acute myocardial infarction or rupture of the aorta. Cocaine sensitizes cardiac cells and causes an increase in contractility. Corresponding high levels of epinephrine secondary to excitement from cocaine cause the individual to be particularly susceptible to cardiac arrest.
The emergency nurse is caring for a client in acute alcohol withdrawal and the nurse has administered chlordiazepoxide IV as prescribed. When monitoring for therapeutic effects, the nurse should include what assessments? Select all that apply. blood pressure heart rate orientation level of consciousness inspection for jaundice bowel sounds
blood pressure heart rate orientation level of consciousness
A client with chronic pain was prescribed oxycodone several months ago and has developed a tolerance, requiring gradual increases in dose. As well, the client admits to experiencing psychological dependence and is showing signs and symptoms of physical dependence. The nurse should advocate for what approach? education about strategies to overcome medication tolerance close monitoring and gradual tapering down of the dose prompt discontinuation of the medication and liberal use of NSAIDs education about how to use PRN naloxone in case of overdose
close monitoring and gradual tapering down of the dose Explanation: Opioid-dependent clients should have their dose gradually reduced, under close supervision. Tolerance is a purely physiologic phenomenon and is not something that can be overcome with education (unlike psychological dependence or addiction). Abrupt discontinuation can result in pain, withdrawal, and physical distress. Naloxone is an emergency measure but does not address the client's underlying challenge.
After reviewing the various frequently abused street drugs, a group of students demonstrates understanding of the information when they identify gamma-hydroxybutyrate as which class? stimulant hallucinogen depressant opioid
depressant Explanation: Gamma-hydroxybutyrate, or GHB, is a depressant. Cocaine or methamphetamine is considered a stimulant. LSD or MDMA is considered a hallucinogen. Fentanyl, morphine, or OxyContin is an opioid.
The nurse who is working in the emergency department admits a 14-year-old client who is exhibiting blurred vision, confusion, impaired breathing, muscle twitches, irregular heartbeat, and excessive sweating. The client's friends report that the client bought a lot of cough syrup and has been drinking it all day. The nurse understands that the client has overdosed on what over-the-counter medication? acetaminophen ibuprofen dextromethorphan guaifenesin
dextromethorphan Explanation: The client is experiencing symptoms of dextromethorphan overdose that include blurred vision, brain damage, confusion, dizziness, drowsiness, excessive sweating, hallucinations, impaired breathing, impaired judgment and mental functioning, loss of consciousness, loss of physical coordination, muscle twitches, nausea and vomiting, paranoia, rapid and irregular heartbeat, seizures, slurred speech, and death. The information provided does not support overdose with acetaminophen, ibuprofen, or guaifenesin.
A nurse is working in the emergency department and is assigned to a client brought in by family members. The family thinks that the client is on methamphetamine. The nurse should assess for: increased appetite. hypertension. bradycardia. stupor.
hypertension. Explanation: Methamphetamine is a CNS stimulant that initially increases heart rate and blood pressure. This drug usually decreases appetite, energizes muscles, and causes some degree of mental and physical alertness.
A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of methamphetamine. cocaine. marijuana. nicotine.
marijuana. Explanation: The major ingredient of Marinol is 9-tetrahydrocannabinol (THC), the active ingredient in marijuana.
