SUBSTANCE DISORDERS
23 A patient sustained a fractured femur while driving under the influence of drugs. Family members indicate that the patient has "dabbled in drugs" for years. When the patient obtains little relief from the prescribed dose of narcotic analgesic, the nurse suspects the ineffective pain relief is related to: a. drug tolerance to the narcotic prescribed. b. the predictable onset of withdrawal symptoms. c. insufficient analgesic dosage to manage the pain. d. the strong likelihood of a history of substance abuse.
ANS: A Tolerance to opiates develops when used repeatedly (i.e., a larger amount of the drug is needed to produce the desired effect). If the patient uses heroin or another opiate individually or in conjunction with other drugs, tolerance may be present. In addition, cross-tolerance develops among CNS depressants, meaning that as tolerance to one drug develops, tolerance develops to all other drugs in the group as well. Although withdrawal and insufficient analgesic medication dosage may result in pain, this patient's assessment data and history are strong indicators of possible drug tolerance. A history of substance abuse would be a "red flag" regarding the possibility of withdrawal symptoms when the patient is no longer receiving any analgesic medications. DIF: Cognitive Level: Analysis REF: Text Page: 448 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Adaptation: Pharmacological and Parenteral Therapies
23 A patient asks a nurse, "What is the primary aim of self-help groups for alcohol abusers?" The nurse should reply, "The goal is first to: a. always be available to help others with an addiction." b. commit to always strive for total abstinence." c. find and rely on the help of the member's sponsor." d. admit powerlessness over the addiction."
ANS: B Although all the options are expectations in the program, admitting to having alcoholism and staying alcohol-free are the aims of the Alcoholics Anonymous (AA) program. DIF: Cognitive Level: Application REF: Text Page: 461 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
23 A novice nurse on the chemical dependence unit mentions, "The drugs of abuse all seem to cause patients to become violent." The best reply would be: a. "Violence is usually associated with abuse rather than with drug withdrawal." b. "There are abused drugs, such as heroin, that rarely produce violent behavior." c. "The observation is generally true since most abusers have observable antisocial tendencies." d. "Ineffective nursing actions toward patients are more responsible for violence than drugs are."
ANS: B Heroin, a CNS depressant, causes sedation. Opiate withdrawal produces flulike symptoms rather than acute psychosis. DIF: Cognitive Level: Application REF: Text Page: 443 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care
23 A nursing diagnosis universally appropriate for patients who abuse mood-altering drugs would be: a. confusion. b. ineffective coping. c. imbalanced nutrition. d. impaired environmental interpretation syndrome.
ANS: B Ineffective coping is a nursing diagnosis that could be used for a patient who abuses any of the mood-altering drugs. Other nursing diagnoses that have wide application to patients who abuse mood-altering drugs are disturbed sensory perception, disturbed thought processes, and disturbed family processes. DIF: Cognitive Level: Comprehension REF: Text Page: 457 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity
23 An unconscious patient is brought to the emergency department. It is suspected the patient overdosed on heroin. What drug can the nurse anticipate will be administered? a. Disulfiram (Antabuse) b. Naltrexone (Revia) c. Methadone (Methadose) d. Acamprosate (Campral)
ANS: B Naltrexone is an opiate antagonist. It will reverse CNS depression caused by opiates. Nalmefene is a newer opiate antagonist that may be ordered in lieu of naltrexone. DIF: Cognitive Level: Application REF: Text Pages: 461-462 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Adaptation: Pharmacological and Parenteral Therapies
23 The following are goals for a patient being treated for alcoholism. Select the order in which these goals should be approached. A. Developing alternative coping skills B. Attaining physiological stabilization C. Learning about dependence and recovery D. Abstinence and development of a support system a. A, B, C, D b. B, D, C, A c. C, D, B, A d. D, C, B, A
ANS: B Physiological stabilization is basic to the success of other goals. When abstinence and a support system to promote abstinence have been developed, attention can be turned to learning about dependence and recovery and developing alternative coping skills. DIF: Cognitive Level: Comprehension REF: Text Pages: 456-457 TOP: Nursing Process: Outcome Identification MSC: NCLEX: Psychosocial Integrity
23 Whenever possible, physical exercise and meditation should be a daily component of the ongoing program of treatment for a person with an addiction. The basis for these aspects of treatment is to make use of the body's natural: a. endocrines. b. endorphins. c. enkephalins. d. epinephrine.
ANS: B The release of endorphins occurs with strenuous exercise and meditation and results in a feeling of well-being and reduced cravings. The remaining options do not present with those results. DIF: Cognitive Level: Comprehension REF: Text Page: 434 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
23 In assessing risks and planning interventions, a nurse should recognize that the longer the half-life of a drug of abuse, the: a. shorter the withdrawal. b. less intense the withdrawal symptoms. c. sooner the patient will begin to crave the drug. d. shorter the withdrawal and the more intense the symptoms.
ANS: B The relevant guidelines are as follows: the longer the half-life of the drug, the longer the withdrawal symptoms will last, and the less intense the withdrawal symptoms will be. DIF: Cognitive Level: Comprehension REF: Text Page: 453 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation
23 A patient has been admitted in an acute psychotic state after ingesting PCP. The nurse has not been able to administer the prescribed dose of benzodiazepine because of the patient's aggressive behavior. The most appropriate intervention under these circumstances would be to: a. provide an alternative activity to channel energy. b. move the patient to a quiet room to minimize stimulation. c. perform a lavage to prevent continuing absorption of drug. d. assign a nurse to stay with the patient to reassure and calm the patient.
ANS: B The safety of the patient and others is an important concern. Patients who have ingested PCP often display unprovoked violence and agitation. It is important that the benzodiazepine be administered as soon as the patient is taken to the seclusion room. The seclusion room provides an environment of minimal stimulation, essential to calming the patient. DIF: Cognitive Level: Application REF: Text Page: 450 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care
23 Care planning for a patient undergoing detoxification for both alcohol and sedative-hypnotics is based on the treatment principle that states that: a. medications are used to treat symptoms as they appear. b. a cross-tolerant drug is used to gradually wean the patient. c. liver function is preserved best by avoiding detoxification drugs. d. forcing fluids is therapeutic since detoxification mainly occurs in the kidneys.
ANS: B Withdrawal from alcohol, barbiturates, and benzodiazepines is similar. The goal is to prevent severe withdrawal symptoms by giving a drug with a similar action that is tapered down and eventually discontinued. DIF: Cognitive Level: Comprehension REF: Text Pages: 441-442 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation
23 The spouse of a patient with alcoholism asks, "How do I respond in a helpful way even though this abuse is so harmful to my family?" The nurse's best response would be: a. "Search the house regularly for hidden alcohol." b. "Include your spouse in family activities whether or not drinking has occurred." c. "Make your spouse responsible for the consequences of the disruptive behavior." d. "Refuse to be supportive when your spouse is under the influence of alcohol."
ANS: C Dysfunctional families often try to protect the patient, avoid confrontation, and blame themselves. These are called enabling behaviors. Making the patient responsible for the consequences of drinking is difficult and usually requires professional support and/or involvement in Alcoholics Anonymous (AA). DIF: Cognitive Level: Application REF: Text Page: 466 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
23 A patient is brought to the emergency department to be assessed after an auto accident. The patient has slurred speech and ataxia and reacts aggressively when examined. The patient's blood alcohol level (BAL) is 0.4 g/dl. From the relationship between the behavior and the BAL, the nurse can make the assessment that the patient: a. takes disulfiram (Antabuse). b. is experiencing alcohol poisoning. c. has ingested acamprosate (Campral). d. has a significantly high tolerance to alcohol.
ANS: D A non-tolerant individual would be comatose with a BAL of 0.4 g/dl. The fact that the patient can walk and talk strongly suggests that the body has developed tolerance to alcohol. DIF: Cognitive Level: Application REF: Text Page: 439 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation
23 A nurse has concerns about erratic behavior and slurred speech of another member of the nursing staff. The most appropriate action for the concerned nurse to take is to: a. immediately confront the impaired nurse with the observation. b. ask other nurses if they have observed anything unusual regarding the nurse in question. c. personally supervise the team member whenever the care involves the preparation of pain medication. d. notify the nursing supervisor to assess the team member's condition and performance.
ANS: D Impairment should be documented by more than one person. The impaired nurse then must be relieved of duty. Further intervention can be planned and implemented at a later time. DIF: Cognitive Level: Application REF: Text Page: 437 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care
23 The nursing intervention of highest priority relative to alcohol withdrawal delirium is: a. application of restraints. b. reorientation of the patient to reality. c. identification of existing social supports. d. maintenance of fluid and electrolyte balance.
ANS: D Maintaining physiological stability is of highest priority. Withdrawal delirium is often accompanied by loss of fluid and electrolytes through vomiting, diarrhea, and diaphoresis. DIF: Cognitive Level: Analysis REF: Text Page: 454 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation
23 The most positive initial action for a health care agency to take for an impaired nurse would be: a. job dismissal. b. eliciting a promise to abstain. c. counseling by the nurse manager. d. referral to the employee assistance program.
ANS: D Most health care agencies have employee assistance programs. Counseling for substance abuse is better provided by professionals in a neutral setting than by peers or administrators in the clinical area. DIF: Cognitive Level: Comprehension REF: Text Page: 468 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care
23 An appropriate short-term goal related to abstinence for a drug abuser would be "The patient will: a. verbalize details of the addiction to significant others." b. declaratively state an intention to abstain from drug use of any sort." c. be able to identify the underlying causes that resulted in an addiction to drugs." d. contact a supportive person if experiencing an urge to use an addictive substance."
ANS: D Patients often become anxious at the thought of never again using the substance to which they are addicted. Therefore it may be helpful to focus on short-term goals, such as using a supportive sponsor when the urge to use occurs. The remaining options reflect long-term goals. DIF: Cognitive Level: Application REF: Text Pages: 456-457 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
23 An individual who is admitted to an alcohol detoxification unit has had no alcohol intake for 3 days. On admission the patient is noted to have tremors, anxiety, insomnia, and disorientation accompanied by tachycardia and diaphoresis. These signs and symptoms are characteristic of the syndrome known as: a. alcoholic hallucinosis. b. alcohol-induced psychosis. c. alcoholic seizure disorder. d. alcohol withdrawal delirium.
ANS: D The signs and symptoms listed are consistent with alcohol withdrawal delirium. It usually has its onset 3 to 5 days after the last drink and lasts 2 to 3 days. It is considered a medical emergency. DIF: Cognitive Level: Comprehension REF: Text Page: 454 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase?
Adolescents
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse?
All the conditions are attributable to the alcohol abuse
The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?
Asians
According to the psychodynamic theory regarding addiction, it is most important that the nurse assesses the client with an alcohol use disorder by considering what?
Asking the client to describe the client's childhood relationship with the client's parents
Disulfiram has been prescribed for a client receiving treatment for alcoholism. Which should be included in the client's plan of care?
Avoid all products containing alcohol
Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?
Benzodiazepines
The mental health nurse should focus on preventative efforts including educational interventions related to the abuse of prescription drugs on which client group?
Both genders between the age of 12 and 17
While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?
CIWA-Ar
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?
Chlordiazepoxide
A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?
Delirium tremens
Clonidine is most effective for which symptom of opioid withdrawal?
Diarrhea Clonidine is most effective against nausea, vomiting, and diarrhea but produces modest relief from muscle aches, anxiety, and restlessness.
Which is an example of a benzodiazepine?
Diazepam
Which of the following medications are used as an alcohol deterrent?
Disulfirum (Antabuse) Explanation: Disulfiram (Antabuse) is a drug given to people recovering from alcoholism who cannot control the compulsion to drink. Ativan, Narcan, and Dolophine are not used as alcohol deterents.
A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?
Elevated temperature
The nurse working in the emergency department admits a client who arrived by ambulance and has respirations of 8 to 12 breaths per minute. The EMTs report finding an empty pill container of diazepam next to the client. The nurse anticipates administering what drug to this client
Flumazenil Explanation: Flumazenil is the antidote for benzodiazepine overdose.
Ecstasy is an example of which type of substance?
Hallucinogen
Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which situation?
Having several clients complain that their pain medication is not working
The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day?
Help them to identify appropriate diversional activities.
When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what?
Helping the client identify positive coping mechanisms
Luke has been admitted for health problems related to drug abuse. During the assessment, he tells the nurse that though he began by smoking the drug, he soon started using the drug by IV injection. However, when he could no longer find a site for IV injection, he started "skin-popping." Which drug and route is he most likely referring to?
Heroin, through subcutaneous administration Explanation: Heroin, the most abused opioid in the United States, has poor oral availability; therefore, abusers often begin by s moking the drug. As abusers become tolerant to the drug, they begin to use the drug by IV injection. When they can no longer find a site for IV injection, they start subcutaneous administration, also known as "skin-popping."
A 47-year-old client has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, the client admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client?
Imbalanced nutrition: less than body requirements related to chronic alcohol intake
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?
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.
When discussing methadone treatment with a client, the nurse should include what?
It decreases the severity of heroin withdrawal symptoms.
An older adult client with liver disease is experiencing alcohol withdrawal. Based on the nurse's understanding of drug therapy, which of the following would the nurse expect to be prescribed?
Lorazepam Antianxiety and sedating drugs, such as benzodiazepines, are titrated downwardly over several days as a substitution for the alcohol. Chlordiazepoxide (Librium) and diazepam (Valium) have longer half-lives and smoother tapers. Lorazepam (Ativan) is better for the older adult and people with liver impairment. Fluoxetine is not used.
Which medication is used to prevent alcohol withdrawal symptoms?
Lorazepam (Ativan)
An client admitted to your emergency department (ED) is experiencing hallucinations. The friend who brought him to the ED indicates that the client has used recreational drugs in the past but has not done so for many weeks. Which of the following drugs can trigger recurrent hallucinations?
Lysergic acid diethylamide (LSD) Explanation: LSD is a potent hallucinogenic that alters sensory perceptions and thought processes. Adverse reactions include "flashbacks," which are characterized by psychological effects and hallucinations that may recur days, weeks, or months after the drug is taken.
A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?
Monday morning
A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?
Naloxone
A 30-year-old client has been brought to the emergency department by emergency medical services with an apparent heroin overdose. In the immediate care of this client, what assessments should the nurse prioritize?
Neurological and respiratory assessments
Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions?
Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered
Which drug would be classified as a hallucinogen?
PCP Explanation: PCP is a hallucinogen. Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.
A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which about the drug?
Reduces the appeal of alcohol
A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6º above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?
Risk for injury
A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with the therapist, the nurse states the nurse is nervous about how coworkers will respond to the nurse now that "they all know I'm a drunk." Which diagnosis best targets the problem implicit in the nurse's remarks?
Situational low self-esteem related to medical condition
A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?
Substance abuse disorders
Which statement most accurately describes the etiology of substance-related disorders?
Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors.
The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?
Tactile hallucinations
The nurse is counseling a group of clients recovering from substance abuse about the nature of denial. Which intervention should the nurse teach the clients to use to help them gain insight into their denial?
Teach them to question why they feel threatened.
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?
The client had six drinks a few hours ago.
The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?
The client most likely has a dual diagnosis since she has both a substance dependence and depression.
A nurse is assessing a client with bizzare and aggressive behavior in the emergency department. Upon questioning, the client's partner discloses that the client had been smoking PCP. While in the emergency department, the client continues to exhibit signs of PCP-induced psychosis and has required physical restraints. What nursing outcome should the nurse prioritize in the care of this client?
The client will be physically safe and without injury.
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?
The drug helps to satisfy the craving for the opioid.
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 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.
A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?
The spouse will refrain from the enabling the client's drinking behaviors.
A client drinks 24 oz. of vodka every day, having gradually increased to this level over the past 2 to 3 years. The client continues to maintain a job and functions well in activities of daily living, relationships, and other aspects of social life. Which term should the nurse use to describe this drinking behavior?
Tolerance
Which of the following refers to the reduction in a drug's effect that follows persistent use?
Tolerance Explanation: Tolerance refers to the reduction in a drug's effect that follows persistent use. Addiction is drug-seeking behaviors that interfere with work, relationship, and normal activities. Withdrawal refers to the physical symptoms and craving for a drug that occur then a person abruptly stops using an abused substance.
Which statement about clients with a dual diagnosis is accurate?
Traditional methods of treatment have not been very successful for these clients.
A nurse is conducting a class for a group of high school students about marijuana use and abuse. The nurse determines that the class needs further discussion when they state which of the following?
Use of marijuana does not lead to addiction.
An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?
Verbalize feeling safe and comfortable.
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?
Wernicke-Korsakoff syndrome
A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?
chlordiazepoxide Explanation: Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants. Varenicline and bupropion are used for smoking cessation. Cannibus is medical marijuana and not used for acute alcohol withdrawal.
A client, being treated for the effects of alcoholism, has begun naltrexone therapy. When assessing this client's laboratory findings, the nurse should prioritize what value?
liver function tests (LFTs) Explanation: A black box warning states that it is necessary to obtain periodic liver function tests during naltrexone therapy and discontinue therapy at signs of increasing hepatic impairment. Because of this warning, LFTs would be more important than creatinine clearance, WBCs, or coagulation tests.
The nurse is providing care for a client physically dependent on an opioid. How is physical dependence best characterized?
physiologic adaptation that results in unpleasant symptoms when the drug is stopped Explanation: Physical dependence involves physiologic adaptation to chronic use of a drug so that unpleasant symptoms occur when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Attempts to avoid withdrawal symptoms reinforce psychological dependence and promote continuing drug use and relapses to drug-taking behavior. Tolerance is often an element of drug dependence in which increasing doses are required.
A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?
"What negative consequences have resulted from your drinking?"
In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?
12 hours
A client with a long history of alcohol abuse is hospitalized. The client's last drink was 12 noon. The nurse would anticipate symptoms of withdrawal occurring no later than what time?
12 midnight
Approximately what percentage of U.S. adults have substance use disorders?
22%
23 When a recovering impaired colleague returns to work, nursing professionals can be most helpful by: a. directly offering support. b. double-checking all the nurse's activities. c. assigning another nurse to watch the recovering nurse closely. d. avoiding mention of the problem unless the recovering nurse mentions it.
ANS: A Direct offers of support are appropriate just as they are if a colleague is dealing with any other health problem. Avoiding mention is like trying to ignore an elephant in the room. Surreptitious observation and checking are demeaning. DIF: Cognitive Level: Application REF: Text Page: 457 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class?
Hallucinogen
A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?
Hallucinogen
The nurse is admitting a patient with acute alcohol intoxication. What is the priority intervention for this patient?
Maintain a patent airway. Explanation: Initial nursing interventions in acutely intoxicated patients are generally directed toward preventing life-threatening or debilitating effects from the substance itself or its withdrawal. The acutely intoxicated person may not be able to protect his or her airway, so doing so is a priority in this situation.
Which drug reverses opioid toxicity?
Naloxone
A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?
Short history of drug use
When assessing a client diagnosed with chronic alcoholism, the nurse addresses potential memory dysfunction by reviewing the client's serum level of what?
Thiamine
A client with chronic alcoholism has been found to have Korsakoff's psychosis. This irreversible complication is characterized by what?
Thiamine, or vitamin B1, deficiency
Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?
Tolerance break
High doses of alcohol produce which effect?
Vomiting
A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when stating what?
"I realize that there is a higher power that can help me."
A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states what?
"I should eat small frequent meals if I get nauseated."
A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?
"It can help to prevent you from drinking."
The nurse is caring for a client who had abdominal surgery 1 day ago. The client is reluctant to get up and ambulate because of the pain. The nurse encourages the client to take the prescribed medication (morphine sulfate) and then ambulate with assistance. The client refuses because of fear of becoming addicted to the medication. What is the nurse's best response to this clien
"Most people who receive pain medications because of a medical reason don't become addicted to the medication." Explanation: Clients who receive opioid medications such as morphine sulfate do not usually experience addiction once the reason for the pain has gone.
What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide?
"When did you have your last drink of alcohol?" Explanation: Chlordiazepoxide is used primarily when clients are in acute alcohol withdrawal. Assessment should be focused on when the client last consumed alcohol to help in the planning of care. While the other questions are not inappropriate, they are not directly related to caring for a client experiencing alcohol withdrawal.
A client has been deemed a candidate for methadone therapy. What instruction should the nurse provide when preparing the client for this treatment plan?
"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 outclient methadone clinic. Neither IV dosing nor food restrictions are required. Dosing is provided on a daily basis to avoid abuse behaviors.
The nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?
"Your parent's alcohol use problem is a chronic disease but can be treated."
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?
8 Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.
23 It will be most helpful for a nurse to describe a relapse to a recovering substance abuser as a(n): a. error from which to learn. b. indicator of treatment failure. c. event with a physiological cause. d. need for additional environmental support.
ANS: A Abstinence and relapse should be viewed as a process rather than distinct events. Recovery is not an all-or-nothing proposition. Success can be measured by improvements, whereas relapse can be viewed as an error from which to learn—a temporary setback on the road to recovery. DIF: Cognitive Level: Application REF: Text Page: 465 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
23 A short-term goal for a patient in the early stage of therapy for addiction to sedatives and stimulants is, "The patient will: a. verbalize dependence on drugs." b. discuss his or her addictive behavior with others." c. recognize the situations in which drugs are abused." d. understand the reasons the dependency on drugs developed."
ANS: A Acknowledging the problem is an appropriate short-term goal. Discussing the addictive behavior with others may or may not be of initial value, while recognizing triggering situations and understanding the reasons that facilitated the addiction are intermediate to long-term goals. DIF: Cognitive Level: Application REF: Text Pages: 456-457 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
23 A patient addicted to both alcohol and benzodiazepines tells a nurse, "I can control my drug use anytime I want to." This statement is an example of the patient's use of: a. denial. b. repression. c. compensation. d. reaction formation.
ANS: A Believing one can control drug use despite addiction is based in the coping mechanism of denial. Denial, rationalization, and minimization are coping mechanisms often used by patients who abuse drugs or alcohol. DIF: Cognitive Level: Application REF: Text Page: 455 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
23 A nurse using cognitive behavioral therapy to treat a patient with substance abuse problems will: a. help the patient to develop self-control and social skills. b. support the use of emotion-focused coping mechanisms. c. focus on addiction as a disease requiring confrontational tactics. d. help the patient see that society shares responsibility for the problem.
ANS: A Cognitive behavioral approaches are aimed at improving self-control and social skills to reduce substance use. Self-control strategies include goal setting, self-monitoring, analysis of drinking antecedents, and learning of alternative coping skills. Social-skills training focuses on learning skills for forming and maintaining interpersonal relationships, assertiveness, and drink refusal. DIF: Cognitive Level: Application REF: Text Pages: 464-465 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
23 In the emergency room a nurse learns that a patient has recently taken a large amount of the drug PCP. The nurse should be ready to provide interventions for: a. acute psychosis, agitation, and violence. b. hypotension, sedation, and respiratory depression. c. heightened sensory perceptions, dizziness, and ataxia. d. paranoid thinking, hyperthermia, hyperactivity, and arrhythmias.
ANS: A PCP ingestion often produces an acutely psychotic state in which the patient is markedly agitated. Violence toward self or others is common. Because the drug produces anesthesia, the patient may be unaware of pain. DIF: Cognitive Level: Application REF: Text Page: 450 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment: Management of Care
23 A nurse suspects that a patient being admitted for outpatient surgery may have a history of alcohol abuse. To further assess this issue, the nurse should consider: a. using a screening tool, such as AUDIT-C to assess the extent of the abuse. b. asking directly if the patient has ever had problems with abusing alcohol. c. interviewing the family because the patient is likely to deny having a problem. d. addressing the suspicion before discharge since it has no direct effect on the patient's surgery.
ANS: A Screening tools like AUDIT-C increase the accuracy of assessment. Exploring alcohol use before a surgical procedure is important, because excessive use may result in the patient experiencing withdrawal symptoms or other alcohol-related problems postoperatively. DIF: Cognitive Level: Application REF: Text Page: 438 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation
23 When designing a teaching plan for a patient taking disulfiram (Antabuse), a nurse should include an explanation on the importance of avoiding certain over-the-counter substances. With the appropriate instruction, which substance could the patient identify as being safe to use? a. Antacids b. Mouthwash c. Cough syrups d. Cold medications
ANS: A Substances that may potentially contain alcohol must be avoided. The use of antacids would be safe. DIF: Cognitive Level: Application REF: Text Page: 462 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
23 A nurse should specifically assess a patient opiate withdrawal for: a. lacrimation, rhinorrhea, dilated pupils, and muscle pain. b. somnolence, constipation, normal pupils, and hypothermia. c. tremors, hypertension, constricted pupils, and deep sleep. d. visual and tactile hallucinations, agitation, and generalized seizures.
ANS: A The classic signs of opiate withdrawal are flulike symptoms and dilated pupils. DIF: Cognitive Level: Comprehension REF: Text Page: 443 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation
