Substance Use and Addictive Disorders Review

A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item? A. Black, tarry stools B. Frequent nausea C. Joining Alcoholics Anonymous D. Pain that increases after meals

A. Black, tarry stools The priority is black (tarry) stools that indicate upper gastrointestinal (GI) bleeding; digestive enzymes act on the blood, resulting in tarry stools. Hemorrhage can occur if erosion extends to blood vessels.

Which drug would you expect a patient on CIWA-Ar protocol to have on their medication list? A. Lorazepam B. Labetalol C. Methadone D. Atropine

A. Lorazepam (Ativan) benzodiazepine, antianxiety agent, sedative/hypnotic Ther. Effects: sedation, decreased anxiety, decreased seizures Common Side Effects: dizziness, drowsiness, lethargy, confusion, Watch out for: respiratory depression/apnea, cardiac arrest, bradycardia, hypotension

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

B. "Everyone is responsible for his own actions." The comment "Everyone is responsible for his own actions" encourages the client to accept responsibility and does not support denial as a defense mechanism.

A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

B. 100 mg/dL --- Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL. A Blood Alcohol Concentration (BAC) of 0.10 (0.10% or one tenth of one percent) means that there are 0.10 g (100 mg) of alcohol for every 100 ml of blood. 0.08% is the legal limit in many states for drivers.

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

C. Assuring the client that the symptoms are part of the withdrawal syndrome Assuring the client that the symptoms are part of the withdrawal syndrome provides reality-based feedback for the client who is withdrawing from alcohol. Physical restraints will increase agitation and should be applied only as a last resort. Encouraging the client to relate the content of hallucinations focuses on the hallucinations rather than on reality. Shadows will increase the chance of visual distortions and illusions.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family who report that his last drink was 1 hour ago. It is now 8pm. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 2300 today and 0800 tomorrow B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted

A. Between 2300 today and 0700 tomorrow Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

A man was admitted to the alcohol rehabilitation unit after being fired for drinking on the job. He states that he does not have a problem with alcohol, handles his booze better than anyone. He says "I haven't missed any more days than my coworkers. My boss is a jerk!" What defense mechanism is the man using? A. Denial B. Projection C. Displacement D. Rationalization

A. Denial - The man denies that he has a problem with alcohol despite being fired for drinking on the job.

An emergency room nurse is assessing a 26 year old female patient who has a oxycodone abuse problem. What symptoms would indicate that she is experiencing withdrawal? A. Fatigue, disorientation, and craving B. Irritability, tremors, and seizures C. Diaphoresis, seizures, and apathy D. Nausea, vomiting, and depression

A. Fatigue, disorientation, and craving are common symptoms of opium withdrawal.

A client with a 20-year history of excessive alcohol use is admitted to the hospital with jaundice and ascites. What is the priority nursing action during the first 48 hours after the client's admission? A. Monitor the client's vital signs. B. Increase the client's fluid intake. C. Improve the client's nutritional status. D. Determine the client's reasons for drinking.

A. Monitor the client's vital signs. A client's vital signs, especially the pulse and temperature, will increase before the client demonstrates any of the more severe symptoms of withdrawal from alcohol. Increasing intake is contraindicated initially because it may cause cerebral edema.

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

A. Risk for injury R/T central nervous system stimulation Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness. Use nursing interventions that prevent and minimize the negative effects of injury should it occur.

A nurse, understanding the possible cause of alcohol-induced amnestic disorder, should take into consideration that the client is probably experiencing which imbalance? A. Thiamine deficiency B. A reduced iron intake C. An increase in serotonin D. Riboflavin malabsorption

A. Thiamine deficiency The deficiency of thiamine (vitamin B1) is thought to be a primary cause of alcohol-induced amnestic disorder. Reduced iron intake, increased serotonin, and riboflavin malabsorption are all unrelated to alcohol-induced amnestic disorder.

Which of the following symptoms is most worrisome in a patient undergoing alcohol withdrawal? A. Bradycardia B. Delirium tremens C. Tachycardia D. Agitation

B. Delirium tremens Delirium tremens (DT) is a rapid onset of confusion seen during alcohol withdrawal. The symptoms of DT include altered mental status, autonomic instability, and even seizures. DT is also characterized by hallucinations such as the sensation of something "crawling" on the patient. DT is the most severe consequence of withdrawal and can be fatal if untreated.

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? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

C. The CAGE questionnaire is a screening tool used to determine the diagnosis of alcoholism. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife 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 a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

C. The client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior. Rationalization may also be observed in defense of opioid misuse/abuse. Pain may be stated as the rationalization.

A client with a history of drug abuse begins group therapy. After attending the first meeting the client says to the nurse, "It helps to know that I'm not the only one with this type of problem." What concept does this statement reflect? A. Altruism B. Catharsis C. Universality D. Transference

C. Universality Universality is the sense that one is not alone in any situation; one purpose of group therapy is to share feelings and gain support from others with similar thoughts and feelings.

Symptoms of alcohol withdrawal include which of the following? A. Euphoria, hyperactivity, and insomnia B. Depression, suicidal ideation, and hypersomnia C. Diaphoresis, nausea and vomiting, and tremors D. Unsteady gait, nystagmus, and profound disorientation

C. diaphoresis, nausea and vomiting, and tremors are common symptoms of alcohol withdrawal.

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? A. Haloperidol B. Chlordiazepoxide C. Methadone D. Phenytoin

Chlordiazepoxide (Librium) benzodiazepine - antianxiety - sedative/hypnotic Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. Ther. Effects: sedation and relief of anxiety Frequent Side Effects: dizziness, drowsiness, sedation, GI upset Give after meals or with milk to minimize GI irritation Do not discontinue abruptly due to risk of seizures and withdrawal

A client with a history of substance abuse is brought to the emergency department for possible overdose. The client is having seizures, is hypertensive, and has hyperthermia. What drug should the nurse consider that the client may have been abusing? A. Alcohol B. Fentanyl C. Oxycodone D. Methamphetamine

D. Methamphetamine Methamphetamine is a stimulant that increases the heart rate and blood pressure. It can cause hyperthermia, convulsions, and death. Alcohol is a central nervous system (CNS) depressant. Overdose of alcohol leads to a decreased level of consciousness, hypotension, hypothermia, and respiratory depression. Fentanyl and oxycodone are opioid and CNS depressants. Overdose leads to hypotension, a decreased level of consciousness, and respiratory depression.

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? A. Increased heart rate and blood pressure B. Tremors, insomnia, and seizures C. Incoordination and unsteady gait D. Nausea, vomiting, diarrhea, and diaphoresis

D. Nausea and vomiting, diarrhea, and diaphoresis (sweatting) Heroin is in the opioid classification. Heroin is a short-acting drug and withdrawal symptoms can occur within 6 to 8 hours after the last dose, peaking 1 to 3 days, and subsiding over a period of 5 to 7 days. Symptoms of withdrawal include: anxiety, agitation, fatigue, insomnia, mental confusion, sweating, vomiting, depression, seizures, hallucinations, and weakness.

The most appropriate nursing intervention for a patient who is being treated for an acute exacerbation of COPD who is not interested in quitting cigarette smoking is to: A. accept the patient's decision and don't intervene until the patient expresses a desire to quit B. realize that some smokers never quit, and trying to assist them increases the patient's frustration C. motivate the patient to quit by describing how continued smoking will worsen the breathing problems D. ask the patient to identify the risks and benefits of quitting and what barriers to quitting are present

D. ask the patient to identify the risks and benefits of quitting and what barriers to quitting are present Rationale: If a tobacco user is unwilling to quit, using the "5 Rs" may motivate the user to quit in the future. These interventions are designed to help tobacco users identify the personal relevance of quitting, potential risks of continuing tobacco use, potential benefits of quitting, and any barriers to quitting.

True of False It is not your responsibility to motivate a patient to change behavior if they do not want to stop abusing drugs.

False The health care setting provides an opportunity for screening and providing teaching regarding substance use. It is your responsibility to motivate the patient to change behavior and refer the patient for treatment and rehabilitation.

True or False Both opioids and sedative-hypnotics are commonly used as CNS depressants?

True Commonly used depressants include sedative-hypnotics and opioids. These drugs cause rapid development of tolerance and dependence. Unintentional overdose frequently occurs with misuse of depressants, especially when they are taken with alcohol or other drugs. The first priority of care is always the CABs. Depressant toxicity can cause death from CNS and respiratory depression.

True or False Substance use disorder occurs on a continuum (mild, moderate, severe) based on the pattern of use and its functional impact.

True Knowing the severity allows the health care team to tailor treatment according to the patients' needs.

A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

A & C are correct The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

Clients addicted to alcohol often use the defense mechanism of denial. What is the reason that this defense is so often used? A. It reduces their feelings of guilt. B. It creates the appearance of independence. C. It helps them live up to others' expectations. D. It makes them look better in the eyes of others.

A. It reduces their feelings of guilt. Alcoholic clients often use denial as a defense against feelings of guilt; this reduces anxiety and protects the self. Denial may make a client seem more stable to others, not independent. Denial deals more with a client's own expectations. Looking better in the eyes of others may be part of the reason, but the bigger motivating factor is to ease guilt feelings.

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

A. "I see that you're worried. We're using medication to ease your wife's discomfort." Recognizing the spouse's feelings and giving simple factual information help to allay anxiety.

An alcoholic patient begins attending AA meetings. Which of the statements by the patient reflects the purpose of this organization? A. "They claim they will help me stay sober." B. "I'll dry out in AA, then I can have a social drink now and then." C. "AA is only for people who have reached the bottom." D. "If I lose my job, AA will help me find another."

A. "They claim they will help me stay sober" AA is a major self-help organization for the treatment of alcoholism. It is based on the ability to remain sober through mutual support. Peers share common experiences. AA accepts alcoholism as an illness and promotes total abstinence as the only cure.

A nurse decides to use the CAGE screening questionnaire with a client admitted for substance abuse. What is the client abusing? A. Alcohol B. Barbiturates C. Hallucinogens D. Multiple drugs

A. Alcohol The CAGE questionnaire is one of the simplest and most reliable screening tools for alcohol abuse. CAGE is an acronym for the key words ( Cut down, Annoyed, Guilty, and Eye-opener) in the four questions asked of people suspected of abusing alcohol. The CAGE questionnaire is not designed to screen clients for barbiturate, hallucinogen, or multiple drug abuse.

A male client with the dual diagnosis of major depression and polysubstance abuse has been attending group therapy. One day the client tells the nurse, "The things they talk about in group don't really pertain to me." What is the most therapeutic response by the nurse? A. Confronting the client with realistic feedback B. Identifying the client's stress-coping tolerance C. Informing the client that he needs to get more involved D. Asking the client what therapy he thinks would be more helpful

A. Confronting the client with realistic feedback The client is using denial to separate from group members and needs realistic feedback to prevent withdrawal. Identifying the client's stress-coping tolerance will not help the client become involved with the group. Informing the client that he needs to get more involved is inadequate; the client first needs to recognize that the problems being discussed are applicable. The client is avoiding treatment. Asking about therapy preferences is not helpful.

What should a nurse identify as the most important factor in rehabilitation of a client addicted to alcohol? A. Motivational readiness B. Availability of community resources C. Accepting attitude in the client's family D. Qualitative level of the client's physical state

A. Motivational readiness Intrinsic motivation, stimulated from within the learner, is essential if rehabilitation is to be successful. Often clients are most emotionally ready for help when they have "hit bottom." Only then are they ready to face reality and put forth the necessary energy and effort to change behavior. The availability of community resources and the qualitative level of the client's physical state are important factors, but neither is the most important one. An accepting attitude on the part of the client's family is an important factor and a helpful one, but not the most important one.

Prolonged alcohol abuse can result in a severe deficiency in what vitamin? A. Thiamine (B1) B. Vitamin C C. Niacin (B3) D. Folate

A. Prolonged alcohol abuse can result in a severe deficiency in thiamine, or vitamin B1 by reducing dietary thiamine intake, impairing gastrointestinal absorption of thiamine, and causing impaired thiamine utilization in cells. Note that individuals who partake in prolonged alcohol abuse may have various other dietary deficiencies.

During the intake interview at a mental health clinic, a client in withdrawal reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply. A. Sadness B. Euphoria C. Loss of appetite D. Impaired judgment E. Psychomotor retardation

A. Sadness and E. Psychomotor retardation Although cocaine is an alkaloid stimulant, depressant effects such as a decreased mood, hypotension, and psychomotor retardation are associated with long-term, high-dose use. Cocaine is a stimulant, and euphoria, loss of appetite, and impaired judgment are all associated with cocaine intoxication, not prolonged high-dose cocaine use.

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he had been a heavy drinker for a number of years. Labs report he has a blood alcohol of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected? A. Several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink

A. Several hours after the last drink Within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use, withdrawal symptoms can begin. Withdrawal symptoms include: coarse tremor of hands, tongue, or eyelids; nausea/vomiting; malaise or weakness; tachycardia; sweating; elevated BP; anxiety; depressed mood/irritability; transient hallucinations or illusions; headache; insomnia.

The nurse refers a client to a self-help group. What does the nurse anticipate that a self-help group such as Alcoholics Anonymous (AA) will help its members learn? A. That their problems are not unique B. That they do not need a crutch to lean on C. That their problems are caused by alcohol D. That the group can stop them from drinking

A. That their problems are not unique Sharing problems with others who have similar problems can help one explore feelings and begin to enhance coping abilities. The Twelve Steps of AA guide alcoholics to seek help from a higher power, which may be religious, based in nature, or the group itself. Problem drinking usually is caused by how the drinker feels about himself or herself. Although AA is a support group, it is a self-help support group. The only one who can stop someone from drinking is the person who is drinking.

A polysubstance abuser makes the statement, "the green and whites do me good after speed." How might the nurse interpret the statement? A. The client abuses amphetamines and anxiolytics B. The client abuses alcohol and cocaine C. The client is psychotic D. The client abuses narcotics and marijuana

A. The client abuses amphetamines (speed) and anxiolytics (the green and whites / barbiturates or CNS depressants) document exactly what the patient said, do not document the interpretation, it's too subjective. Ask clarifying, open-ended questions if appropriate.

A patient admits to self-medicating their depression with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.

A. The individual is experiencing psychological dependency. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

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

A. Tremors in both hands make it difficult for the client to hold a cup. D. The client's bed linens and pajamas had to be changed during the night as a result of increased diaphoresis. E. The usually cooperative client becomes verbally abusive when asked to lower the volume of the television. Diaphoresis and tremors are physical characteristics of alcohol withdrawal. Agitation is a psychosocial characteristic of alcohol withdrawal. Systolic blood pressure would rise rather than fall if the client were experiencing alcohol withdrawal. Insomnia, rather than drowsiness, is a physical characteristic of alcohol withdrawal.

The nurse would suspect cocaine toxicity in the patient who is experiencing A. agitation, dysrhythmias, and seizures B. blurred vision, restlessness, and irritability C. diarrhea, nausea / vomiting, and confusion D. slow, shallow respirations, bradycardia, and hypotension

A. agitation, dysrhythmias, and seizures Symptoms may occur with a cocaine overdose: agitation; increases in temperature, pulse, respiratory rate, and BP; cardiac dysrhythmias and myocardial infarction; hallucinations; seizures; and possible death.

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

B. "Huffing paint can damage your lungs, kidneys, and liver." Inhaled toxins become systemic and cause damage to major organs such as the lungs, liver, and kidneys. Inhalants tend to produce euphoria, not just a mild state of intoxication. Huffing paint will not produce major withdrawal symptoms. All toxic substances that are inhaled become systemic and cause damage to major organs such as the lungs, liver, and kidneys.

A man was admitted to the alcohol rehabilitation unit after being fired for drinking on the job. He states that he does not have a problem with alcohol, handles his booze better than anyone, and his boss is just a jerk. What is the nurse's best response? A. "maybe your boss was mistaken." B. "you are here because your drinking was interfering with your work." C. "Get Real! You're a boozer and you know it." D. "Why do you think your boss is a jerk?"

B. "You are here because your drinking was interfering with your work" is the best choice from those given.

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 last 24 hours. Which client symptom should the nurse immediate report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

B. Blood pressure of 180/100 mm Hg The nurse should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

A nurse overhears a client in a mental health hospital talking on the unit telephone. The conversation concerns a "fix" to be brought to the unit during visiting hours. The nurse knows that the client, who has a history of drug use, has a contract with the primary healthcare provider promising not to use street drugs while being treated in the inpatient unit. What is the best nursing intervention? A. Phoning the client's primary healthcare provider and asking how the situation should be handled B. Calling an immediate staff meeting to share the information and develop a plan for intervention C. Calling security to make certain that hospital policies are enforced to maintain a safe environment D. Confronting the client regarding the telephone conversation, then reporting the incident to the primary healthcare provider

B. Calling an immediate staff meeting to share the information and develop a plan for intervention The nurse must bring this information to the attention of the treatment staff for their information and action; an immediate team approach is necessary. The primary healthcare provider may be called after the staff is informed of the situation and the treatment plan is modified. Calling security is premature; this may or may not be necessary. The client will eventually be confronted, but a plan for how and when this will take place needs to be developed; safety is an issue that must be considered.

A 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 dependence? A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics The client may require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client's response to another drug.

A nurse is planning care for a client with substance-induced persisting dementia resulting from long-term alcohol use. Which nutritional problem, in addition to the effect of alcohol on brain tissue, has contributed to substance-induced persisting dementia? A. Increase in serotonin B. Deficiency of thiamine C. Reduction in iron intake D. Malabsorption of riboflavin

B. Deficiency of thiamine Substance-induced persistent dementia is caused by a prolonged deficiency of vitamin B1 (thiamine) and the direct toxic effect of alcohol on brain tissue. Increase in serotonin, reduction in iron intake, and malabsorption of riboflavin are problems that are unrelated to substance-induced persisting dementia caused by alcoholism.

After a cocaine binge an individual is found unconscious and is admitted to the hospital with acute cocaine toxicity. What should the initial nursing action be directed toward? A. Being understanding B. Establishing a patent airway C. Maintaining a drug-free environment D. Establishing a therapeutic relationship

B. Establishing a patent airway The client is unconscious and unable to meet physical needs; a patent airway, breathing, and circulation are essential needs. Understanding and support are important once the client's physical condition has stabilized. Establishment of a therapeutic relationship will increase in importance once the client's physical condition has stabilized.

A patient is brought to the emergency department by a family member. The patient has been agitated for the past several hours and has alternated between grandiosity and expressing a desire to commit suicide. Upon examination, the patient is diaphoretic, hypertensive, and tachycardic. Intoxication with which of the following substances would contribute to these symptoms? A. Benzodiazepine B. Methamphetamine C. Alcohol D. Marijuana

B. Methamphetamine

Which substance abuse involves injection of the drug to produce intense excitement, energy, boldness, and paranoia similar to that produced by cocaine? A. Freons B. Methamphetamine C. Model airplane cement D. Lysergic acid diethylamide

B. Methamphetamine Methamphetamine is an inexpensive, easily available drug commonly known as crank, meth, and crystal. Upon injection or swallowing, it causes intense excitement, energy, boldness, and paranoia when compared to cocaine. Freon is a substance found in canned air dusters, which on inhalation could cause fatal cardiac dysrhythmias. Model airplane cement is a volatile substance that upon inhalation causes altered sensation. Lysergic acid diethylamide is a drug that can produce hallucinations and euphoria.

From which of the following symptoms might the nurse identify a chronic cocaine user? A. Clear, constricted pupils B. Red, irritated nostrils C. Muscle aches D. Conjunctival redness

B. Red, irritated nostrils

Alcohol abuse-induced thiamine deficiency can cause which of the following? A. vomiting and diarrhea B. Wernicke-Korsakoff syndrome C. decreased ejection fraction D. hypoglycemia

B. Wernicke-Korsakoff syndrome is caused by a severe deficiency in thiamine, often seen in severe alcohol dependency. It is characterized by visual disturbances, ataxia, and altered consciousness.

When admitting a patient, the nurse must assess the patient for substance use based on the knowledge that long-term use of addictive substances leads to A. the development of coexisting psychiatric illnesses B. a higher risk for complications from underlying health problems C. potentiation of effects of similar drugs taken when the individual is drug free D. increased availability of dopamine, resulting in decreased sleep requirements

B. a higher risk for complications from underlying health problems Rationale: Almost every drug of abuse harms some tissue or organ of the body.

A patient admitted for scheduled surgery had a positive brief screening test result for an alcohol use disorder. Which initial action is most appropriate? A. notify the health care provider B. complete a detailed alcohol use assessment C. initiate a referral to a specialty treatment center D. provide patient teaching on postoperative health risks

B. complete a detailed alcohol use assessment Rationale: Patients with a positive brief screening test result need to undergo a more detailed assessment, including the substance used, dose taken, method of intake, and length of time of substance use. After the assessment is complete, alert the HCP because the patient who uses substances requires specialized care.

Substance use problems in older adults are usually related to A. use of drugs and alcohol as a social activity B. misuse of prescribed and OTC drugs and alcohol C. continuing the use of illegal drugs initiated during middle age D. a pattern of binge drinking for weeks or months with periods of sobriety

B. misuse of prescribed and OTC drugs and alcohol Rationale: HCPs are much less likely to recognize substance use in older adults than in younger adults. Older adults may misuse prescription and over-the-counter drugs and alcohol.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal. Prevent seizures and seizure-related injury.

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

C. A reaction to disulfiram (Antabuse) Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

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

C. Administering the prescribed medication to the client to subdue the agitated behavior The nurse must administer the prescribed medication to the client to subdue the agitated behavior in this life-threatening situation. The client's central nervous system (CNS) is overstimulated, and seizures and death can occur. CNS-depressant medications, usually benzodiazepines, are needed to blunt the withdrawal effects. The client needs intervention because the hallucinations are not dreams. Focusing on the sensations associated with the withdrawal syndrome is not therapeutic; it is not helpful to tell the client that the hallucinations are not real, because they are real to the client. Validation reinforces the client's distorted perceptions of reality, is not helpful, and may be unsafe.

A nurse discusses the philosophy of Alcoholics Anonymous (AA) with the client who has a history of alcoholism. What need must self-help groups such as AA meet to be successful? A. Trust B. Growth C. Belonging D. Independence

C. Belonging Self-help groups are successful because they support a basic human need for acceptance. A feeling of comfort and safety and a sense of belonging may be achieved in a nonjudgmental, supportive, sharing experience with others. AA meets dependency needs rather than focusing on trust, growth, and independence.

A 20-year-old woman is admitted to the labor and delivery unit after reporting that she is experiencing severe contractions. She is 38 weeks +2 days' gestation. External fetal monitoring has been initiated. During the assessment the nurse notes that the woman is sweating profusely, has dilated pupils and irregular respirations, is hypertensive, and continues to complain of very severe pain with contractions. The external fetal monitor shows fetal tachycardia with excessive fetal activity. What should the nurse suspect? A. Heroin abuse B. Marijuana use C. Cocaine abuse D. Alcohol withdrawal

C. Cocaine abuse These signs are seen in pregnant women who abuse cocaine. Yawning, diaphoresis, rhinorrhea, restlessness, and excessive tearing are seen in heroin abuse. Chronic redness in the eyes, drowsiness, forgetfulness, and an unusual odor on the clothing or breath are signs of marijuana use. Anxiety, nervousness, shakiness, and slow speech are seen with alcohol withdrawal. The possibility of seizure activity must also be considered.

A nurse encourages a client to attend Alcoholics Anonymous (AA) meetings after discharge. What do self-help groups such as AA help their members do? A. Set long-term goals. B. Limit excessive drinking. C. Foster changes in behavior. D. Identify underlying causes of behavior.

C. Foster changes in behavior. Self-help groups deal with behavior and changes in behavior rather than with underlying causes of behavior. Small steps are encouraged and, when attained, are reinforced by the group. AA is known for encouraging its members to deal with one day at a time.

A nurse is caring for a client who is recovering from an acute episode of alcoholism. Which component of a therapeutic diet should the nurse encourage the client to consume? A. High fat B. Low calorie C. High protein D. Low carbohydrate

C. High protein A high-protein diet helps correct the malnutrition associated with alcoholism. High fat places a demand on the compromised liver to produce bile. A low- to moderate-fat diet is preferred. A high-calorie, not low-calorie, diet is needed to promote tissue repair and improve nutritional status. A high-carbohydrate, not low-carbohydrate, diet is needed to prevent catabolism and promote anabolism.

Upon admission for symptoms of alcohol withdrawal a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, HR 110, RR 28, and Temp 36C; dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping

C. Imbalanced nutrition: less than body requirements The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

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

C. Marked loss of memory Alcoholic clients have loss of memory and adapt to this by unconsciously filling in with false information areas that cannot be remembered. Ideas of grandeur do not occur in this disease. A need to get attention is unrelated to confabulation. These individuals are not purposely lying but instead are trying to cover memory losses.

A nurse is counseling a client who is experiencing substance abuse delirium. What communication strategies should be used by the nurse when working with this client? A. Encouraging the client to practice self-control B. Using humor when communicating with the client C. Offering an introduction to the client at each meeting D. Approaching the client from the side rather than the front

C. Offering an introduction to the client at each meeting Clients with delirium have short-term memory loss; therefore it is necessary to reinforce information. A client experiencing delirium is unable to participate in a discussion about self-control. Humor is inappropriate and may cause the client to feel uncomfortable. Approaching the client from the side rather than the front may initiate a startle response, causing the client to become fearful.

The nurse observes that 12 hours after birth the neonate is hyperactive and jittery, sneezes frequently, has a high-pitched cry, and is having difficulty suckling. Further assessment reveals increased deep tendon reflexes and a diminished Moro reflex. What problem does the nurse suspect? A. Cerebral palsy B. Neonatal syphilis C. Opioid drug withdrawal D. Fetal alcohol syndrome

C. Opioid drug withdrawal These signs are indicative of withdrawal from an opioid with typical changes occurring in the central nervous system; the newborn should be monitored during the first 24 to 48 hours. The signs of cerebral palsy usually manifest later in infancy. The signs of syphilis are a low-grade fever and a copious serosanguineous discharge from the nose. The signs of fetal alcohol syndrome are growth deficiencies in length, weight, and head circumference, plus distinctive faces.

A nurse withholds a prescribed opioid medication from a client requesting to be treated for intractable pain because the nurse fears the client will become addicted. In this situation, the nurse is adhering to which ethical principle? A. Veracity B. Autonomy C. Paternalism D. Beneficence

C. Paternalism Paternalism occurs if the nurse interferes with the individual's autonomy by disregarding the client's choices; the client has requested to be treated with a medication that has been prescribed by the healthcare team and the nurse is refusing to give it because of unfounded personal beliefs. The client's priority is pain relief and the nurse should be working with other health team members to achieve this objective. Veracity is defined as telling the truth. Autonomy, as an ethical principle, means that the nurse respects the client and the choices that are made. Beneficence commonly is referred to as "doing good;" it is related to the nurse's duty to help clients further their legitimate interest within the boundaries of safety.

A client with a history of heavy drinking is brought to a psychiatric facility in a stupor. On the day after admission the client is confused, disoriented, and delusional. What alcohol-related symptom does the nurse decide the client may be experiencing? A. Amnesia B. Hallucinations C. Withdrawal syndrome D. Uncomplicated dementia

C. Withdrawal syndrome The central nervous system is affected by the abrupt withdrawal of alcohol intake, resulting in the classic responses indicated in the situation; they occur 1 to 3 days after the cessation of alcohol intake.

While in the alcohol rehabilitation unit, the patient's friends come to visit. After the leave, the nurse smells alcohol on the patient's breath. Which of the following would be the best intervention at this time? A. search for evidence in the room B. ask, "have you been drinking alcohol?" C. Send a urine specimen to the lab for drug screening D. Tell the patient, "Your friends cannot come to the unit to visit you again."

C. send a urine specimen to the lab for drug screening objective data needs to be documented. Also document the observation of alcohol smell.

Which of the following is the most commonly abused drug? A. alcohol B. marijuana C. tobacco D. amphetamines

C. tobacco Tobacco is the most commonly abused drug. The effects of nicotine on the brain are identical to those of other highly addictive stimulant drugs, including cocaine. Smoking is the most harmful method of nicotine use and can injure nearly every organ in the body. Tobacco use is the leading cause of preventable illness and death in the United States.

While caring for a patient who is experiencing alcohol withdrawal, the nurse should (select all that apply): A. monitor neurologic status on a routine basis B. provide a quiet, nonstimulating, dimly lit environment C. pad the side rails and place suction equipment at the bedside D. orient the patient to environment and person with each contact E. administer antiseizure drugs and sedatives to relieve symptoms during withdrawal

Correct: A, C, D, E Incorrect: B Rationale: For patients in withdrawal from substance use, nursing management includes monitoring neurologic status and vital signs and administering medications to prevent the progression of symptoms and increase patient comfort. Maintaining a well-lit environment that reduces sharp contrasts and shadows is important to reduce external stimuli. To prevent injury associated with seizure activity, nurses should keep suction equipment, an Ambu bag, and an oral or nasopharyngeal airway at the patient's bedside and use padded side rails.

A nurse is providing information about Alcoholics Anonymous (AA) meetings to a client with a history of alcohol abuse. What will be required when the client attends AA meetings? A. Speaking aloud at weekly meetings B. Maintaining controlled drinking after 6 months C. Promising to attend at least 12 meetings yearly D. Acknowledging an inability to control the alcoholism

D. Acknowledging an inability to control the alcoholism A major premise of AA is that to be successful in achieving sobriety, clients with an alcohol abuse problem must acknowledge their inability to control the use of alcohol. There are no rules of attendance or speaking at meetings.

A patient is brought to the emergency department (ED) by a friend. The patient is unresponsive and respirations are slow and shallow. Which of the following is the priority intervention? A. Check the patient's blood glucose level B. Ask the friend if they were using illicit drugs C. Administer naloxone, per protocol D. Administer 100% oxygen per nasal canula

D. Administer 100% oxygen per nasal canula

Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

D. Chlordiazepoxide (Librium) and phenytoin (Dilantin) It's common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.

A school nurse is teaching a high school health class about inhalant abuse. What serious effect of using inhalants should the nurse discuss? A. Esophageal varices B. Acute electrolyte imbalances C. Extrapyramidal tract symptoms D. Death in one third of first-time users

D. Death in one third of first-time users Use of inhalants, called "huffing," is most often seen in preadolescent males in rural areas, and it can be lethal in overdose. Esophageal varices are associated with alcoholic cirrhosis. Acute electrolyte imbalances are associated with alcoholic cirrhosis and are related to malnutrition, dehydration, and ascites. Extrapyramidal tract symptoms are associated with typical antipsychotic medications.

A nurse is caring for a client with a diagnosis of acute pancreatitis and alcoholism. The client asks, "What does my drinking have to do with my diagnosis?" What effect of alcohol should the nurse include when responding? A. Promotes the formation of calculi in the cystic duct B. Stimulates the pancreas to secrete more insulin than it can immediately produce C. Alters the composition of enzymes so they are capable of damaging the pancreas D. Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas

D. Increases enzyme secretion and pancreatic duct pressure that causes backflow of enzymes into the pancreas Alcohol stimulates pancreatic enzyme secretion and an increase in pressure in the pancreatic duct. The backflow of enzymes into the pancreatic interstitial spaces results in partial digestion and inflammation of the pancreatic tissue. Although blockage of the bile duct with calculi may precipitate pancreatitis, this is not associated with alcohol. Alcohol does not deplete insulin stores; the demand for insulin is unrelated to pancreatitis. Although the volume of secretions increases, the composition remains unchanged.

A newborn is diagnosed as having neonatal abstinence syndrome (NAS) after exhibiting jitteriness, irritability, and a shrill cry. What is the priority nursing care? A. Administering an opioid antagonist B. Limiting fluid intake to inhibit vomiting C. Assessing for age-appropriate developmental level D. Reducing environmental stimuli to promote relaxation

D. Reducing environmental stimuli to promote relaxation The neonate who is withdrawing from opiates is very sensitive to light, noise, and surrounding activity; the infant must be kept calm and comfortable to reduce overreaction to stimuli. Morphine or other opioids are administered to those infants who have loose stools and other gastrointestinal problems resulting from withdrawal. Some of these infants need tranquilizers or sedatives to minimize the effects of withdrawal. An opioid antagonist would lower the seizure threshold and is contraindicated in this clinical situation. Fluid intake must be increased to prevent dehydration in the infant who vomits. Assessment for developmental status is not the priority; physical needs take precedence.

These are symptoms experienced at toxic levels of which potentially-abused substance: restlessness, hypervigilance, agitated delirium, impaired judgment, and paranoia with psychotic symptoms. A. Tobacco B. Opioids C. Alcohol D. Stimulants

D. Stimulants Frequently abused stimulants include cocaine, amphetamines, and methamphetamines. Stimulant overdose is frequent, and deaths have occurred. At toxic levels, the patient experiences restlessness, hypervigilance, agitated delirium, impaired judgment, and paranoia with psychotic symptoms.

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking? A. Teach pursed-lip breathing. B. Encourage the client to reduce emotional stress. C. Obtain a referral to a smoking-cessation program in the community. D. Suggest that the client limit smoking to one pack of cigarettes a day.

D. Suggest that the client limit smoking to one pack of cigarettes a day. Limiting the number of cigarettes smoked daily may be an effective first step toward smoking cessation. An all-or-none approach often is not effective. The ultimate goal is to eliminate smoking entirely.

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

D. To assess for fine tremors The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Tremors are part of the CIWA-Ar assessment - Ask the pt to hold their arms out - Observe shakes in the hands while they eat and while they relax - For fine tremors the nurse can also ask the pt to stick out their tongue

What behavior by a client with a long history of alcohol abuse is an indication that the client may be ready for treatment? A. Drinking only socially B. Not drinking for a week C. Hospitalization for detoxification D. Verbalizing an honest desire for help

D. Verbalizing an honest desire for help When clients with alcohol problems voice a desire for help, it usually signifies that they are ready for treatment, because they are admitting they have a problem. Adherence to an alcohol treatment program requires abstinence. A week is too short a time to signal readiness for treatment. Hospitalization alone is not an indication that the client is really ready for treatment, because many factors can influence admission.

A patient is admitted to the ED and smells strongly of alcohol. The patient's partner reports that he has been a heavy drinker for the last 25 years. Which of the following assessment findings are consistent with long-term chronic alcohol abuse? SELECT ALL THAT APPLY A. The client reports weak leg muscles, and his gait is unsteady B. The client's abdomen is distended C. The client reports he was coughing up some blood D. The client reports he has double vision E. Blood tests reveal a low white blood cell count

all of the answers are correct A. weak leg muscles, and gait is unsteady - alcoholic myopathy B. abdomen is distended - ascites C. coughing up some blood - esophagitis, or possibly portal hypertension leading to esophageal varices D. double vision - diplopia associated with Wernicke's Enceph. E. low white blood cell count - leukopenia