Substance Abuse

The client, admitted 2 days ago to a medical unit, has a long history of heavy alcohol abuse. The nurse should monitor for which acute complications related to alcohol abuse? (Select all that apply) 1. Seizures 2. Pancreatitis 3. GI bleeding 4. Exophthalmos 5. Delirium tremens (DTs)

1,2,3,5 1. Seizures 2. Pancreatitis 3. GI bleeding 5. Delirium tremens (DTs)

The nurse is caring for the client who has methamphetamine toxicity. Which interventions, if prescribed, should the nurse include in the client's plan of care? (Select all that apply) 1. Give olanzapine 10 mg IM q2h prn to treat agitation 2. Allow the client to sleep and eat as much as desired 3. Administer labetalol 20 mg IV to control hallucinations 4. Monitor 1:1 to protect client from harm to self and others 5. Encourage involvement in the therapeutic treatment milieu

1,2,4 1. Give olanzapine 10 mg IM q2h prn to treat agitation 2. Allow the client to sleep and eat as much as desired 4. Monitor 1:1 to protect client from harm to self and others

The student participating in college sports is suspected of abusing anabolic steroids and is referred to the college's health service. Which nursing assessment findings are consistent with anabolic steroid abuse? (Select all that apply) 1. Acne vulgaris 2. Aggressive behavior 3. Heavy menstruation 4. Urinary tract infection 5. Thickening of the hair 6. Edema of the hands and feet

1,2,4,6 1. Acne vulgaris 2. Aggressive behavior 4. Urinary tract infection 6. Edema of the hands and feet

The client who abuses marijuana reports liking the drug for its perceived effects. Which experiences, if reported by the client, should the nurse attribute to marijuana use? (Select all that apply) 1. Euphoria 2. Increased energy 3. Sexual enhancement 4. Appetite suppression 5. Improved fine-muscle coordination

1,3 1. Euphoria 3. Sexual enhancement

The hospitalized client has a history of weekly moderate alcohol use. Which symptoms assessed by the nurse indicate that the client may be experiencing alcohol withdrawal? (Select all that apply) 1. Agitation 2. Hypotension 3. Tachycardia 4. Hallucinations 5. Tongue tremor

1,3,4,5 1. Agitation 3. Tachycardia 4. Hallucinations 5. Tongue tremor

The client is started on buprenorphine with naloxone sublingual for opiate addiction. Which statements indicate that the client understood the nurse's instructions about the medication? (Select all that apply) 1. "The medication can slow or stop my breathing. I should only take what is prescribed." 2. "I'm taking this non-habit-forming medications to help stop my craving for opiate drugs." 3. "If I suddenly stop taking buprenorphine and naloxone, I could experience withdrawal." 4. "I can take the tablet whole or crush it and take it with food to make it more palatable." 5. "This drug is highly abused; I should not share this or keep it where it can be stolen."

1,3,5 1. "The medication can slow or stop my breathing. I should only take what is prescribed." 3. "If I suddenly stop taking buprenorphine and naloxone, I could experience withdrawal." 5. "This drug is highly abused; I should not share this or keep it where it can be stolen."

The client has developed paranoia as a result of regular methamphetamine use. The nurse uses cognitive reappraisal to confront the client's persecutory thoughts. Which question should the nurse ask the client? 1. "How can you look at this differently?" 2. "Why would they want to cause you harm?" 3. "What did you do that makes others not like you?" 4. "How do you feel when others create problems for you?"

1. "How can you look at this differently?" Cognitive restructuring involves stopping maladaptive thoughts and replacing them with more realistic ones. Reappraisal can be achieved by examining different perspectives

The client is being discharged from treatment for addiction to alprazolam and will be attending an addiction self-help group. Which statement indicates that the client has an accurate understanding of maintaining sobriety according to 12-step-help principles? 1. "I cannot take any mood-altering drugs, or I run the risk of relapsing." 2. "I will have to stay away from situations that I find anxiety-producing" 3. "I've learned how to safely use my nerve pills to avoid overusing them." 4. "Instead of these pills, I'll drink a small glass of wine when I feel anxious."

1. "I cannot take any mood-altering drugs, or I run the risk of relapsing." Alcoholics Anonymous and other 12-step self-help groups promote total abstinence as the only cure. Persons addicted to drugs cannot safely use any mood-altering chemicals

The mother of the 14-year-old tells the clinic nurse that she is concerned that her child may be "doing some sort of drug." The adolescent is confused and has difficulty answering questions clearly but admits to sniffing solvents in the family's garage. Which statement by the nurse is correct? 1. "Most inhalants cause serious nervous system and respiratory system damage." 2. "There is a little risk for physical harm; the effects will wear off within a few hours." 3. "By seeking help early you can discourage your child from future drug use." 4. "Your child will sleep for long periods after the drug effects are gone."

1. "Most inhalants cause serious nervous system and respiratory system damage." This statement is correct. Most inhalants produce some neurotoxicity with cognitive, motor, and sensory involvement. Respiratory effects range from coughing and wheezing to dyspnea, emphysema, and pneumonia

The newly hospitalized client has Korsakoff's psychosis from alcohol abuse. Which intervention should the nurse plan? 1. Administer thiamine intravenously 2. Give octreotide acetate intravenously 3. Apply soft wrist restraints for safety 4. Start oxygen at 2 L/min per nasal cannula

1. Administer thiamine intravenously Confusion, loss of recent memory, and the use of confabulation occurs in Korsakoff's psychosis in alcoholics due to a deficiency in thiamine. Thiamine (vitamin B1) deficiency occurs from insufficient intake and malabsorption of nutrients from the toxic effects of alcohol. Thiamine use may reduce confusion and prevent further impairment

The client with a history of poly substance abuse is being medically detoxified in an acute care hospital. The client reported recently using alcohol, oxycodone, crack cocaine, and marijuana. In planning for detoxification, which substance for detoxification should be the nurse's priority? 1. Alcohol 2. Marijuana 3. Oxycodone 4. Crack cocaine

1. Alcohol Alcohol should have priority when detoxifying because it produces the most serious withdrawal syndrome, which can be fatal. Withdrawal symptoms include tremors, nausea/vomiting, malaise, weakness, tachycardia, sweating, elevated BP, anxiety, depressed mood, irritability, hallucinations, headache, insomnia, and seizures. Safety issues during alcohol withdrawal are a concern

The 19-year-old client regularly abuses dextromethorphan (DXM). Which activity, if performed under the influence of dextromethorphan, places the client at the greatest risk for complications related to DXM abuse? 1. Dancing at a nightclub 2. Competing in a swim meet 3. Snow-skiing on spring break 4. Fishing from a shaded shoreline

1. Dancing at a nightclub When consumed in large quantities, dextromethorphan (Delsym, Robitussin DM) can cause hyperthermia. Hyperthermia is a concern for clients who take DXM while exerting themselves and becoming hot, such as while dancing

The nurse is planning care for the client receiving treatment for benzodiazepine abuse. Place the interventions in the order that they should be implemented during the client's course of treatment. 1. Review lifestyle changes that will need to be made 2. Take vital signs 3. Administer lorazepam as prescribed 4. Emphasize personal responsibility for abstaining from substance abuse 5. Provide information about the symptoms of withdrawal 6. Encourage oral fluids

2,3,6,5,4,1 2. Take vital signs 3. Administer lorazepam as prescribed 6. Encourage oral fluids 5. Provide information about the symptoms of withdrawal 4. Emphasize personal responsibility for abstaining from substance abuse 1. Review lifestyle changes that will need to be made

The spouse of the client who is currently in inpatient treatment for substance abuse tells the nurse, "We've done this so many times. I don't think my spouse is every going to change. Do you think it's time for me to get a divorce?" Which response by the nurse is most helpful? 1. "You don't think your spouse is ever going to change?" 2. "It sounds like you're feeling discouraged in your marriage." 3. "Your spouse will likely continue to use and need treatment again." 4. "That's your decision; I can't tell you whether you should get a divorce."

2. "It sounds like you're feeling discouraged in your marriage." Using validation assists the spouse in examining his or her feelings and facilitates further exploration of how that person is being affected by the substance abuse behavior

The nurse is counseling the client who uses methamphetamine regularly. Which statements demonstrate the client using pathological projection as a coping mechanism? 1. "I'm here to get help. Everything will be all right again if I can just stop using drugs." 2. "My dad and I don't get along. He thinks that I'm a failure and can't do anything right." 3. "I'm not giving up alcohol, just the methamphetamine, I never had a problem with alcohol." 4. "I can't go back to work. I'd be so embarrassed if anyone found out I've been in treatment."

2. "My dad and I don't get along. He thinks that I'm a failure and can't do anything right." Projecting (blaming) involves placing the responsibility for one's behavior on someone or something else besides the person. The client is blaming the drug use and lack of behavior change on what the client believes about his or her dad. This is negative self-talk and is self-deprecating

The nurse suspects that a coworker is working while impaired. Which initial action should be taken by the nurse? 1. Contact the Drug Enforcement Agency (DEA) 2. Contact the nurse manager to report the incident 3. Confront the nurse and suggest to "get help." 4. File an anonymous report with the state's board of nursing

2. Contact the nurse manager to report the incident The nurse suspecting a coworker of working while impaired should contact the nurse manager, who will investigate the allegation and initiate the appropriate action

The nurse is counseling the client with a substance abuse disorder. Which defense mechanism is the nurse most likely to observe the client using in response to a stressful event? 1. Repression 2. Regression 3. Sublimation 4. Reaction formation

2. Regression Defense mechanisms utilized by persons who abuse substances include denial, regression, rationalization, and projection. Regression is the retreat to an earlier level of development and the comfort measures associated with that level of functioning; it may include behaviors such as crying, helplessness, rocking, or childlike behavior

The client taking disulfiram has a throbbing headache, diaphoresis, and sudden vomiting. Which conclusions should the nurse explore first? 1. The client may have developed influenza 2. The client may have recently consumed alcohol 3. The client may have taken a cough suppressant 4. The client may have eaten foods that interact with disulfiram

2. The client may have recently consumed alcohol Throbbing headache, diaphoresis, and vomiting are symptoms associated with recent alcohol ingestion while taking disulfiram (Antabuse). Recent alcohol consumption should be explored first

The nurse educator is presenting a program on drug abuse to new nurses on the mental health unit. When explaining cocaine abuse, which street names for cocaine should the nurse include in the discussion? 1. Weed, chaw, fags 2. Toot, snow, crack 3. Uppers, dexies, crystal 4. Blue silk, cloud 9, white knight

2. Toot, snow, crack Street names for cocaine include toot, snow, and crack. Other street names are coke, blow, lady, and flake

The nurse completed an admission interview and assessment of the client who is under the influence of cocaine. Which findings should the nurse attribute to the client abusing cocaine? (Select all that apply) 1. Decreased BP and HR 2. Lack of attention to the interview process 3. Hypersensitivity in response to personal questions 4. Underreporting the amount of cocaine used on a regular basis 5. Wheezing, coughing, red nose, and runny nose

3,5 3. Hypersensitivity in response to personal questions 5. Wheezing, coughing, red nose, and runny nose

The client often avoids talking about cocaine use by refocusing on other problems such as losing a job and family discord. Which is the most helpful response by the nurse when the client avoids discussing using cocaine? 1. "Has your cocaine use helped you to cope with these problems in the past?" 2. "You need to consider that all these problem are related to your cocaine use." 3. "How do you think these problems will change once you no longer use cocaine?" 4. "You can't do anything about these while here. Just focus on getting off cocaine."

3. "How do you think these problems will change once you no longer use cocaine?" Other problems encountered by the client are often related to drug use. Using a therapeutic communication technique of helping the client see relationships between drug use and other problems helps provide insight into the severity of the substance abuse

The client states, "I don't see any problems with smoking a little weed. It isn't addictive." Which response by the nurse is most accurate? 1. "Marijuana is a natural chemical that has may therapeutic uses, but it is still illegal to use." 2. "Marijuana is not addictive. The danger is that it often leads to abuse of more illicit drugs." 3. "Marijuana has effects similar to alcohol, hallucinogens, and sedatives that are addictive." 4. "There are no withdrawal symptoms, so it is controversial whether marijuana is addictive."

3. "Marijuana has effects similar to alcohol, hallucinogens, and sedatives that are addictive." Even at moderate doses, marijuana produces effects similar to those of CNS depressants, hallucinogens, and sedative-hypnotics. Psychological addiction has been shown to occur with marijuana

The nurse is teaching home health aides about monitoring for alcohol abuse in older adults. Which response by an aide indicates a need for further teaching? 1. "Alcohol abuse is the largest category of substance abuse problems in older adults." 2. "I should monitor more closely for alcohol abuse in single male clients who smoke." 3. "Retirement and freedom from work and family pressures tend to decrease alcohol use." 4. "Confusion, malnutrition, and self-neglect may be signs of alcohol abuse in the elderly."

3. "Retirement and freedom from work and family pressures tend to decrease alcohol use." This statement indicates more teaching is needed. Past work and family responsibilities may have kept a potential abuser from drinking too much, whereas isolation due to retirement and lack of family nearby can trigger alcohol abuse

The nurse is educating the client on methadone prescribed for replacement therapy while in an outpatient treatment program for heroin addiction. The client asks, "How is taking a pill going to help me stay substance-free?" Which statement is the nurse's best reply? 1. "The methadone will give you the same high, so you won't want heroin anymore." 2. "The methadone will cause you to become very sick if you take heroin at the same time." 3. "The methadone 'replaces' heroin in your body, so you will have fever cravings for heroin." 4. "The methadone causes sedation; you'll sleep better, so you can participate in your treatment."

3. "The methadone 'replaces' heroin in your body, so you will have fever cravings for heroin." Methadone (Methadose) is one of the more common medications for opioid detoxification. Methadone is a long-acting agonist that, in effect, displaces heroin (or other abused opioids) and restabilizes the receptor site, thereby lessening the cravings for heroin and reversing opioid withdrawal symptoms

The client states, "I go out just about every weekend and drink pretty heavily with my friends. Does that mean I'm dependent on alcohol?" Which is the best response by the nurse? 1. "You're not dependent on alcohol if you never drink to the point of intoxication." 2. "It sounds like you feel guilty about how much you drink. Tell me more about this." 3. "With dependence, you have a strong need to drink and feel uncomfortable if you don't." 4. "You should be dependent. Consuming alcohol pretty heavily every weekend is excessive."

3. "With dependence, you have a strong need to drink and feel uncomfortable if you don't." Dependence involves a compulsive or chronic requirement for a chemical. The need is so strong as to generate physical or psychological distress if left unfilled. More than 3 drinks per day or more than 7 drinks per week in women, more than 4 drinks per day or more than 14 drinks per week in men, or more than 1 drink per day if over age 65 is high-risk alcohol consumption

The nurse is interacting with the client who abuses methamphetamine. The client states, "I don't plan to quit meth. I can work for days when I'm high." Which is the best response by the nurse? 1. "You'll exhaust yourself working days when you're high." 2. "You can't see the real problem yet because you're in denial." 3. "You say you don't plan to quit. Do you think using drugs helps you?" 4. "Good point. You probably do work long hours while you are on meth."

3. "You say you don't plan to quit. Do you think using drugs helps you?" The focus is on current reality, and the nurse must be nonjudgmental. Restatement is a neutral response that assists the client in reexamining the thought process

The parent expresses concern that her son, newly admitted to the mental health unit, may be using methamphetamine. Which nursing assessment findings are consistent with methamphetamine abuse? 1. hypotension and bradycardia 2. Constricted pupils and fatigue 3. Anorexia and recent weight loss 4. Bruises and scrapes on extremities

3. Anorexia and recent weight loss Weight loss is associated with methamphetamine and other stimulant abuse due to their ability to cause a rise in metabolic rate and varying degrees of anorexia

The nurse is in the working phase of a relationship with the client being treated for substance abuse. Which plan would be appropriate during this phase of treatment? 1. Assess the client's readiness to change substance-abusing behavior 2. Evaluate the effective of the client's newly adapted coping skills 3. Confront the client's denial that substances have negatively impacted daily life 4. Determine the extent to which substances have impaired the client's functioning

3. Confront the client's denial that substances have negatively impacted daily life In the working phase, the nurse should determine the strength of the client's denial system and assist the client to accept the fact that substances are causing problems

The nurse is assigned four clients at a substance abuse crisis clinic. Place the clients in the order of priority for care by the nurse. 1. The client with cannabis use who has a P of 145, dry mouth, and states having an increased appetite 2. The client with opioid abuse who has pinpoint pupils, BP of 84/46, and temperature of 103.6F (39.8C) 3. The client with a flushed face, unsteady gait, and incoordination from alcohol intoxication 4. The client with opioid abuse who has dilated pupils, diaphoresis, RR of 44, BP of 205/100, and now is having radiating chest pain

4,2,3,1 4. The client with opioid abuse who has dilated pupils, diaphoresis, RR of 44, BP of 205/100, and now is having radiating chest pain 2. The client with opioid abuse who has pinpoint pupils, BP of 84/46, and temperature of 103.6F (39.8C) 3. The client with a flushed face, unsteady gait, and incoordination from alcohol intoxication 1. The client with cannabis use who has a P of 145, dry mouth, and states having an increased appetite

The client in group therapy states, "I've enjoyed using methylphenidate because of how it makes me feel." The nurse should identify which additional statement with methylphenidate use? 1. "I love how it gave me energy to stay up all night." 2. "It really helped me sleep when I wasn't very tired." 3. "The bad part was that I gained weight when using it." 4. "I could really focus. I liked not worrying about anything."

4. "I could really focus. I liked not worrying about anything." Methylphenidate (Ritalin, Concerta) is a nonamphetamine stimulant that increases mental alertness, decreases distractibility, and aids in concentration and focus, but it can produce a false sense of euphoria and well-being

The nurse is discharging the client from an inpatient treatment program for cocaine abuse. Which statement by the client indicates an accurate understanding about the disease process of addiction? 1. "I'm really going to try to stay off cocaine. I'm not worried about alcohol. I've never had any problem with a glass or two of wine with dinner." 2. "Once my cravings go away, I won't need to go to Narcotics Anonymous (NA) anymore. I'll be recovered and will be able to stay away from using cocaine." 3. "I feel much better after talking to my therapist. I didn't realize that I was hurting so much emotionally. I must have been using to deal with my emotional problems." 4. "I didn't realize that staying off drugs meant changing my thoughts and emotions. I thought I could just learn to stop using cocaine. NA will help me make these changes."

4. "I didn't realize that staying off drugs meant changing my thoughts and emotions. I thought I could just learn to stop using cocaine. NA will help me make these changes." An emphasis on the requirement for a total lifestyle change is necessary for preventing relapse. Through NA people learn to change negative attitudes and behaviors into positive ones

The client expresses ambivalence about quitting smoking and the fear of "getting fat" and "looking like a cow." The client wonders if that is worse than smoking. Which response by the nurse is most helpful? 1. "We could set up a diet for you to start at the same time to prevent you from gaining any weight." 2. "Don't you think it would be much better to breathe more easily, even if you gain a little weight?" 3. "You don't want to quit smoking because you think you might gain weight. Do you see yourself as overweight?" 4. "It sounds like you are afraid of weight gain. Tell me about both the good and bad things that might happen if you give up smoking."

4. "It sounds like you are afraid of weight gain. Tell me about both the good and bad things that might happen if you give up smoking." Fear of weight gain is a barrier for many who want to quit smoking. Acknowledging fears develops empathy. Exploring fears as well as benefits helps the client in decision-making. Cognitive reappraisal helps the client face fears more realistically. This is the most helpful response by the nurse.

The 19-year-old is given a court order to enter treatment for cocaine abuse. The client threatens to leave the treatment facility AMA. Which statement by the nurse demonstrates an accurate understanding of the client's options? 1. "The client is of legal age and can leave if he wants; we can't stop him from leaving." 2. "Due to the court order, the client is not allowed to leave and will be placed in seclusion." 3. "The client is allowed to leave as long as the court is informed; I'll prepare the documents." 4. "The client cannot leave and will be returned to treatment, or another option, by court order."

4. "The client cannot leave and will be returned to treatment, or another option, by court order." With involuntary commitments, state standards require a specific impact or consequence. Court hearings determine commitment and length of stay, and a person is not allowed to leave and would be returned for treatment if attempting AMA

The client who is addicted to cocaine states, "I don't really need treatment. Things just got a little out of hand, causing some problems. I can handle things on my own. I really need to get back to my business." Which response by the nurse best assists the client to break through denial and get insight into the severity of the addiction? 1. "Tell me more about the business you feel you must return to at this time." 2. "You don't really need to be here? Tell me more about what you are thinking." 3. "You don't feel you need treatment. How often have you been using cocaine?" 4. "You say you can handle things, but you found yourself with a lot of problems."

4. "You say you can handle things, but you found yourself with a lot of problems." This statement assists the client to work on accepting the fact that using substances has caused problems in significant life areas

The client receiving treatment for substance dependence has not been attending group therapy. Which statement by the nurse to confront this behavior is best? 1. "Why don't you want to go to group therapy? Other users are there waiting for you to attend." 2. "Talking about personal issues with others can be difficult. Try talking to the therapist alone." 3. "Therapy is important to your treatment. You need to attend therapy if you want to get better." 4. "You say you want to get better, but you are not actively participating in your treatment plan."

4. "You say you want to get better, but you are not actively participating in your treatment plan." The nurse should address the behavior in a matter-of-fact, nonjudgmental manner by using confrontation with a caring approach. Confrontation interferes with the client's ability to use denial. A caring attitude avoids putting the client on the defensive.

The nurse is assessing the client who presents with generalized fatigue, dry mouth, tachycardia, and an increased appetite. Which additional findings from the client's history and physical exam should alert the nurse to explore possible marijuana abuse? 1. Paranoia 2. Flashbacks 3. Gastric disturbances 4. Conjunctival infection

4. Conjunctival infection Physical symptoms of cannabis intoxication include conjunctival infection, generalized fatigue, dry mouth, tachycardia, and an increased appetite

The client is receiving clonidine to relieve selected symptoms of opioid withdrawal. Which assessment is most important for the nurse to complete before administering clonidine? 1. Check for presence of dilated pupils 2. Investigate recent nausea or vomiting 3. Test for abnormally heightened reflexes 4. Verify that the BP is not low

4. Verify that the BP is not low The nurse should verify the client's BP prior to administration and should withhold clonidine (Catapres) if the systolic BP is lower than 90 mm Hg or the diastolic BP is below 60 mm Hg