Chapter 23: Substance-Related and Addictive Disorders

A client diagnosed with chronic alcohol use disorder is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to AA is most appropriate for the nurse to discuss with the client during discharge teaching? 1. After discharge, the client will attend 90 AA meetings in 90 days. 2. After discharge, the client will rely on an AA sponsor to control alcohol cravings. 3. After discharge, the client will incorporate family members in AA attendance. 4. After discharge, the client will seek appropriate deterrent medications through AA.

1

A client diagnosed with depression and substance use disorder has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to try nonpharmacological interventions first? 1. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. 2. Sedative-hypnotics are expensive and have numerous side effects. 3. Sedative-hypnotics interfere with necessary rapid eye movement sleep. 4. Sedative-hypnotics are not as effective as antidepressant medications for promoting sleep.

1

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an ED by family, who reports that his last drink was 1 hour ago. It is now midnight. When will the nurse expect this client to exhibit withdrawal symptoms? 1. Between 3 a.m. and 11 a.m. 2. Shortly after a 24-hour period 3. At the beginning of the third day 4. Withdrawal is individualized and cannot be predicted

1

A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? 1. Gross tremors, delirium, hyperactivity, and hypertension 2. Disorientation, peripheral neuropathy, and hypotension 3. Oculogyric crisis, amnesia, ataxia, and hypertension 4. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

1

A client is asking the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the nurse's best reply? 1. "This medication will help you maintain your abstinence." 2. "This medication will cause uncomfortable symptoms if you consume alcohol." 3. "This medication will decrease the effect alcohol has on your body." 4. "This medication will lower your risk of experiencing a complicated withdrawal."

1

A lonely, depressed, divorced person has been self-medicating with cocaine for the past year. Which term should the nurse use to best describe the client's situation? 1. Psychological addiction 2. Physical addiction 3. Substance addiction 4. Social addiction

1

Which is the priority nursing diagnosis for a client experiencing alcohol withdrawal? 1. Risk for injury related to (R/T) central nervous system (CNS) stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1

Which of the following nursing statements exemplifies important insights to promote effective intervention with clients diagnosed with substance use disorders? Select all that apply. 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my parent's alcoholism, I need to examine my attitude toward these clients." 3. "Drinking is legal, so the diagnosis of substance use disorder is an infringement on client rights." 4. "Opioid addicts are typically uneducated, unrefined individuals who will need a lot of education and social skills training." 5. "I can fix clients diagnosed with substance use disorders as long as I truly care about them."

1 2 4

Which of the following student statements about the complications of hepatic encephalopathy indicate further student teaching is needed? Select all that apply. 1. "A diet rich in protein will promote hepatic healing." 2. "This condition causes a rise serum ammonia, leading to impaired mental functioning." 3. "In this condition, blood accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

1 3

Which are associated with codependent behaviors among nurses? Select all that apply. 1. Overspending 2. Social isolation 3. Perfectionism 4. Personal identity 5. Denial

1 3 5

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the past 24 hours. Which client symptom should the nurse immediately report to the ED physician? 1. Antecubital bruising 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 4. Dehydration

2

A parent who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient drug rehabilitation program. Which client statement indicates to the nurse that the client has a positive prognosis? 1. "I'm not going to use heroin ever again. I know I can do it this time." 2. "I cannot control my use of heroin. It's stronger than I am." 3. "I'm going to get all my children back. They need their parent." 4. "Once I deal with my childhood physical abuse, recovery should be easy."

2

The nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance use disorder? 1. Narcotic pain medication is contraindicated for all clients with active substance use problems. 2. Clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance use disorder. There is an obvious PCA malfunction. 4. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

2

The nurse is reviewing STAT laboratory data of a client presenting in the ED. What is the minimum blood alcohol concentration at which the nurse should expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

2

The triage nurse notes a client with a history of alcohol use disorder has an elevated heart rate, palpitations, shortness of breath, and a dry cough. Which best explains the client's symptoms? 1. Alcoholic myopathy 2. Alcoholic cardiomyopathy 3. Esophagitis 4. Portal hypertension

2

When assessing a client with polysubstance abuse, the nurse recognizes that withdrawal from which substance may require a life-saving emergency intervention? 1. Dextroamphetamine (Dexedrine) 2. Diazepam (Valium) 3. Morphine (Astramorph) 4. Phencyclidine (PCP)

2

Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? 1. Darken the room to reduce stimuli to prevent seizures. 2. Assess aggressive behaviors to prevent injury to self or others. 3. Administer lorazepam (Ativan) to reduce the rebound effects on the CNS. 4. Teach the negative effects of alcohol on the body.

2

Which of the following are symptoms of inhalant intoxication? Select all that apply. 1. Bradycardia 2. Euphoria 3. Hyperactive reflexes 4. Ataxia 5. Nystagmus

2 4 5

A client diagnosed with alcohol use disorder joins a community 12-step program and states, "My life is unmanageable." Which of the following indicates the nurse's interpretation of the client's statement? 1. The client is using minimization as an ego defense. 2. The client is ready to sign an AA contract for sobriety. 3. The client has accomplished the first of 12 steps advocated by AA. 4. The client has met the requirements to be designated as an AA sponsor.

3

A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports this dose is no longer helping him fall asleep. Which nursing diagnosis appropriately documents this problem? 1. Ineffective coping R/T unresolved anxiety and medication tolerance as evidenced by (AEB) substance abuse 2. Anxiety R/T poor sleep AEB difficulty falling asleep 3. Disturbed sleep pattern R/T chlordiazepoxide (Librium) tolerance AEB difficulty falling asleep 4. Risk for injury R/T addiction to chlordiazepoxide (Librium)

3

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "I just need to work harder to get him there on time." Which is the appropriate nursing response? 1. "Why do you assume responsibility for his behaviors?" 2. "Codependency is a typical behavior of spouses of alcoholics." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

3

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the ED experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. The nurse recognizes that the client's symptoms indicate which of the following? 1. Alcohol poisoning 2. Cerebrovascular accident (CVA) 3. A reaction to disulfiram (Antabuse) 4. A reaction to tannins in the red wine

3

During group therapy, a client diagnosed with alcohol use disorder states, "I would not have boozed it up if my spouse hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should the nurse interpret this statement? 1. The client is using denial by avoiding responsibility. 2. The client is using displacement by blaming his spouse. 3. The client is using rationalization to excuse his alcohol dependence. 4. The client is using reaction formation by appealing to the group for sympathy.

3

On the first day of a client's alcohol detoxification, which nursing intervention is the priority? 1. Encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage per protocol. 4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

3

Students in a community health nursing class recently attended a lecture regarding tobacco use. Which student statement reflects the lecturer's teaching was effective? 1. "The percentage of adult men who smoke is higher than that of women and adolescents." 2. "Nicotine is the most widely used substance in the United States." 3. "Clients with severe mental illness have higher rates of smoking than those without mental illness." 4. "Smoking increases the risk of infant death due to inborn cardiac and respiratory defects."

3

The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? 1. By asking directly if the client has ever had a problem with alcohol 2. By using the Clinical Institute Withdrawal Assessment scale 3. By using a screening tool, such as the CAGE questionnaire 4. By referring the client for physician evaluation

3

Upon admission for symptoms of alcohol withdrawal, a client states, "I haven't eaten in 3 days." Assessment reveals blood pressure of 170/100 mm Hg, pulse of 110 bpm, respirations of 28 breaths/min, and a temperature of 97°F with dry skin, dry mucous membranes, and poor skin turgor. Which of the following is the priority nursing diagnosis? 1. Knowledge deficit 2. Denial 3. Deficient fluid volume 4. Ineffective individual coping

3

A nurse in the ED assesses a 17-year-old client exhibiting symptoms of opioid intoxication. Which should be the nurse's first action? 1. Contact the parents. 2. Administer oxygen. 3. Open the crash cart. 4. Administer naloxone (Narcan).

4

The nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? 1. To assess for emotional strength and regret 2. To assess for Wernicke-Korsakoff syndrome 3. To assess for tachycardia 4. To assess for fine tremors

4

The nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? 1. "Only oral ingestion of alcohol will cause a reaction when taking this drug." 2. "It is safe to drink beverages that have only 12% alcohol content." 3. "This medication will decrease your cravings for alcohol." 4. "Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug."

4

The nurse is interviewing a client in an outpatient drug treatment clinic. To promote success in the recovery process, which initial outcome should the nurse expect the client to accomplish? 1. The client will identify one person to turn to for support. 2. The client will give up all old drinking buddies. 3. The client will be able to verbalize the effects of alcohol on the body. 4. The client will correlate life problems with alcohol use.

4

Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "I will attend Narcotics Anonymous (NA) meetings when I can't control my cravings." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

4

Which client statement indicates a knowledge deficit related to substance use? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur suddenly." 4. "Everyone smokes marijuana. It's harmless."

4

Which medication orders should the nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? 1. Haloperidol (Haldol) and fluoxetine (Prozac) 2. Carbamazepine (Tegretol) and donepezil (Aricept) 3. Disulfiram (Antabuse) and lorazepam (Ativan) 4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

4

Which term should the nurse use to describe the administration of a CNS depressant during alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

4