Varcarolis 19: Substance-Related and Addictive Disorders

The nurse is performing an assessment on a patient being admitted with a diagnosis of alcohol dependence who reports it's been 6 hours since the last drink. The information supports which assumption about the appearance of withdrawal symptoms? A. The danger time has passed B. Signs may appear at any time C. The next hour could be critical D. Withdrawal has likely already started

B. Alcohol withdrawal is most likely to occur within the first 6 to 8 hours after abrupt cessation; however, it can occur over the next several days. Therefore, the option suggesting the danger has passed as well as the one suggesting that a specific time can be predicted can be eliminated. The option that withdrawal has already started is not supported by the information presented.

A patient with a history of opiate abuse asks the nurse, "Why do I crave this stuff so much?" The nurse responds, knowing that the patient's craving is a result of which factor? A. Development of tolerance for the drug B. Lack of naturally occurring endorphins C. Patient's psychological dependency on opiates D. Typical abuse pattern for central nervous system depressants

B. Craving opiates is a result of the diminished production of endorphins that occurs with long-term abuse of the drug. Tolerance is the need for increased amounts of the drug to achieve the desired effects. Psychological dependency is the emotional need for the drug. Cravings are not typical of all central nervous system depressant abuse.

When assessing a patient for a possible physical dependency on alcohol, the nurse should ask which priority question? A. "Are you drinking more than you did 5 years ago?" B. "How do you feel when you haven't had a drink all day?" C. "Does your drinking ever cause you problems with your family?" D. "Do you ever feel that you really need a drink to calm your nerves?"

B. Physical dependency results in withdrawal symptoms; therefore, the option addressing that topic is the priority question. An increase in alcohol consumption may be an indicator of alcohol tolerance. Alcohol abuse is described as being willing to continue the use of alcohol regardless of the problems doing so causes. Needing a drink to calm the nerves is an indicator of a psychological dependency.

A patient tells the nurse, "After many years, I finally quit smoking. Now I use e-cigarettes only." Which response should the nurse provide? A. "Using e-cigarettes is now more socially acceptable than using traditional cigarettes" B. "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals" C. "Nicotine is a powerful addiction. Quitting smoking is a big step toward adopting a healthier lifestyle" D. "I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke"

B. The nurse should educate the patient. E-cigarettes are advertised as safe; however, they contain nicotine as well as other hazardous chemicals.

A patient who is known to abuse drugs is admitted to the psychiatric unit. Which medication should the nurse anticipate administering to a patient who is exhibiting benzodiazepine withdrawal symptoms? A. Perphenazine (Trilafon) B. Diphenhydramine (Benadryl) C. Chlordiazepoxide (Librium) D. Isocarboxazid (Marplan)

C.

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

C. 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.

The nurse at a local medical clinic reviews phoned-in requests from patients for prescription refills. As the nurse confers with the health care provider about which prescription refill requests should be authorized, which refill request should be considered first? a. Codeine 10 mg PO q4h PRN for an adult with a persistent cough b. Hydroxyzine (Vistaril) 25 mg PO TID PRN for an adult who experiences uncomfortable muscle spasms c. Lorazepam (Ativan) 1 mg PO BID for an adult who has taken it daily for 3 years for episodes of anxiety d. Paregoric (camphorated tincture of opium) 2 mg PO q6h PRN for an adult experiencing severe diarrhea

C. Lorazepam is a benzodiazepine. Sudden withdrawal from this class of medications has medical complications, including the possibility of death; hence this refill request has priority.

A nurse teaches a patient diagnosed with an alcohol addiction about a new prescription for naltrexone (ReVia, Vivitrol). Which comment by the patient indicates the teaching was effective? A. "This medicine will stop my cravings for alcohol" B. "I should take this medication only when I feel cravings to drink alcohol" C. "This medicine is one part of a bigger treatment plan to help me stay sober" D. "I should not use products than contain alcohol, such as cough medicine and aftershave lotion"

C. Naltrexone (ReVia, Vivitrol) reduces the desired pleasant feelings related to alcohol or opioid intake and helps to reduce drug cravings. It is part of a total program for maintaining sobriety.

A nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to inset a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? A. Call security B. Call the police C. Call the nursing supervisor D. Lock the coworker in the medication room until help is obtained

C. Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. D is an inappropriate and unsafe action.

The nurse should monitor the patient with a history of heroin addiction for which signs/symptoms of heroin withdrawal? A. Constipation, insomnia, and hallucinations B. Staggering gait, slurred speech, and violent outbursts C. Nausea, vomiting, diarrhea, muscle aches, and diaphoresis D. Decreased heart rate and blood pressure, and dry nose, mouth, and skin

C. The client who is experiencing opioid withdrawal (e.g., from heroin) may experience dysphoric mood, nausea, vomiting, diarrhea, abdominal cramping, muscle aches, diaphoresis and piloerection, runny eyes (lacrimation) and nose (rhinorrhea), yawning, low-grade fever, restlessness, insomnia, anxiety, mydriasis, and increased pulse and blood pressure. Therefore, the other options are incorrect.

Before giving the patient disulfiram, what should the psychiatric home health nurse determine? A. If there is a history of hyperthyroidism B. When the last full meal was consumed C. If there is a history of diabetes insipidus D. When the last alcoholic drink was consumed

D. Disulfiram is an adjunctive treatment for some patients with chronic alcoholism to assist in maintaining enforced sobriety. Because patients must abstain from alcohol for at least 12 hours before the initial dose, the most important assessment is when the last alcoholic intake was consumed. The medication should be used cautiously in patients with hypothyroidism, diabetes mellitus, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in persons with severe heart disease, psychosis, or hypersensitivity to the medication. Food is not a consideration with this medication.

When discussing an individual's tendency to substance abuse, the nurse should identify which assessment data as a primary biological factor? A. The patient is a 25-yr-old male B. The patient is employed as a firefighter C. The patient is of German ethnic background D. The patient has 2 family members who have abused

D. Family history of substance abuse is considered the key biological factor in affecting individual abuse. The remaining options do not have the same degree of effect as does the correct option.

Which medication should be administered to prevent symptoms of withdrawal in a laboring patient who routinely uses heroin? A. Butorphanol B. Pentazocine C. Nalbuphine D. Dolophine

D. Methadone is a narcotic analgesic used to prevent withdrawal symptoms in pregnant women who have stopped using heroin or other opioid drugs. Butorphanol, pentazocine, and nalbuphine are all narcotic agonist-antagonists and may cause acute withdrawal symptoms in the women and fetus.

The nurse should monitor a client with a history of opioid abuse for which signs and symptoms associated with opioid withdrawal? A. Increased appetite, irritability, anxiety, restlessness, and altered concentration B. Tachycardia, mild hypertension and fever, sweating, nausea, vomiting, and marked tremor C. Depression, high drug craving, fatigue, altered sleep patterns, hypertension, agitation, and paranoia D. Increased pulse and blood pressure, low-grade fever, yawning, restlessness, anxiety, diarrhea, and mydriasis

D. Opioids are central nervous system depressants. They generally cause drowsiness and the feeling of being out of touch with the world. Withdrawal occurs within 12 hours after the last dose. D identifies the signs and symptoms associated with opioid withdrawal. A describes cocaine withdrawal. B identifies signs associated with nicotine withdrawal. C describes alcohol withdrawal.

The nurse is assessing a patient who has admitted 24 hours ago for a fractured humerus. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? A. Hypotension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, coarse hand tremors, lethargy D. Hypertension, changes in level of consciousness, hallucinations

D. Symptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, changes in level of consciousness, agitation, fever, and delusions.

A young adult has heavily abused alcohol and prescription drugs since mid-adolescence. This individual now has an ataxic gait and uses a cane. Which comment by the nurse presents reality while demonstrating compassion? A. "I know you must feel self-conscious about using a cane at your age, but it will help prevent falls" B. "Addiction is a fatal disease. If you continue to drink like you have done in the past, you will not live another 10 years" C. "It's time to face your addiction. You are disappointing your family and must stop drinking for the sake of the people that love you" D. "Addiction is powerful. You are young yet cannot walk without a cane. If you do not make changes, your health will continue to suffer"

D. This recognize the power of addiction but presents the reality of the consequences of continued use.

Thiamine supplementation and other nutritional vitamin support measures are prescribed for patients who have been using alcohol to prevent or decrease the risk of which complication? A. Cirrhosis B. Delirium tremens C. Esophageal varices D. Wernicke-Korsakoff syndrome

D. Wernicke-Korsakoff syndrome is the only item in the options that is directly and significantly associated with severe nutritional deficits, particularly of B vitamins. Delirium tremens may be partially attributed to nutritional deficits but will not occur unless alcohol withdrawal ensues. The other options are sequelae of chronic alcohol abuse but are owing to other effects on the gastrointestinal system.

The patient diagnosed with alcoholism has been prescribed medication therapy to assist in the maintenance of sobriety. The nurse will provide the patient with education focused on which medication that will most likely be prescribed? A. Clonidine B. Disulfiram C. Pyridoxine hydrochloride D. Chlordiazepoxide hydrochloride

B. Disulfiram is a medication used for alcoholism, and it aids in the maintenance of sobriety. Clonidine is an antihypertensive medication. Pyridoxine hydrochloride is used in the treatment of vitamin B6 deficiency. Chlordiazepoxide hydrochloride is an antianxiety medication (a benzodiazepine) that is used in the management of acute alcohol withdrawal symptoms.

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

A. 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 patients for barbiturate, hallucinogen, or multiple drug abuse.

Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically D. Provide stimulation in the environment E. Provide reality orientation as appropriate F. Maintain NPO status

A, B, C, & E. When the patient is experiencing withdrawal from alcohol, the priority for care is to prevent the patient from harming self or others. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would provide a low-stimulation environment to maintain the patient in as calm a state as possible. The nurse would reorient the patient to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake need to be maintained.

What are the most likely characteristics of a patient who abuses alcohol? A. Male gender B. Is not married C. Abuses drugs as well as alcohol D. Employed in a minimal wage job E. History of at lease 1 suicide attempt

A, C, E. Males are more likely to be alcohol abusers. A person who abuses alcohol is at a high risk for self-inflicted injury, and simultaneous use of more than 1 substance is very common. Few of those abusing alcohol receive needed treatment. Alcoholics are found at all economic strata and occur equally among married and single clients.

A patient with a long history of alcohol abuse develops cirrhosis of the liver. The patient exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this patient's ascites? A. Impaired portal venous return B. Impaired thoracic lymph channels C. Excess production of serum albumin D. Enhanced hepatic deactivation of aldosterone secretion

A. The congested liver impairs venous return, leading to increased portal vein hydrostatic pressure and an accumulation of fluid in the abdominal cavity. Although lymph channels in the abdomen become congested, facilitating the leakage of plasma into the peritoneal cavity, it is primarily the increased portal vein hydrostatic pressure that causes the accumulation of fluid in the abdominal cavity. Increased serum albumin causes hypervolemia, not ascites. As fluid is trapped in the peritoneal cavity, circulating blood volume drops and aldosterone secretion increases, not decreases; aldosterone secretion is related to the renin-aldosterone system.

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

A. 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.

A patient is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the patient that which is the first step in this 12-step program? A. Admitting to having a problem B. Substituting other activities for gambling C. Stating that the gambling will be stopped D. Discontinuing relationships with people who gamble

A. The first step in the 12-step program is to admit that a problem exists. Substituting other activities for gambling may be a strategy, but it is not the first step. The remaining options are not realistic strategies for the initial step in a 12-step program.

A patient who was in an automobile accident is admitted to the hospital with multiple injuries. Approximately 14 hours after admission, the patient begins to experience signs and symptoms of withdrawal from alcohol. Which signs and symptoms should the nurse connect to alcohol withdrawal? Select all that apply. A. Fatigue B. Anxiety C. Runny nose D. Diaphoresis E. Psychomotor agitation

B, D, E. Anxiety is commonly associated with withdrawal from alcohol. When a person is withdrawing from alcohol, associated autonomic hyperactivity causes an increased heart rate and diaphoresis. The withdrawal of alcohol affects the CNS, resulting in excited motor activity. Fatigue is associated with withdrawal from caffeine or stimulants. A runny nose and tearing of the eyes are associated with withdrawal from opioids.

A patient with suspected opioid overdose has received a dose of naloxone hydrochloride. The patient subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the patient, knowing which piece of information? A. The patient may next become suicidal B. These are signs of opioid withdrawal C. These effects will last only a few moments D. The patient may otherwise sign out against medical advice

B. Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours after administration of naloxone hydrochloride, depending on the opioid involved, the degree of dependence, and the dose of naloxone. The remaining options are incorrect interpretations.

What are the common side effects of regular cocaine usage that the nurse should be aware of when assessing this patient? A. Nausea, fatigue, and extreme hunger B. Anxiety, dysphoria, and extreme suspicion C. Seizures, hoarseness, and electrolyte imbalance D. Lethargy, sexual arousal, and hormone imbalance

B. Stimulating the CNS with cocaine most commonly causes anxiety, dysphoria, and extreme suspicion. These symptoms can progress to fear, hallucinations, paranoid delusions, and violent behavior when a cocaine user is not using regularly. Nausea is not a side effect. Euphoria and loss of appetite, rather than fatigue and hunger, are side effects. Seizures, hoarseness, and electrolyte imbalance are not common side effects of cocaine use. An increase in energy, rather than lethargy, occurs. Some cocaine users believe that the drug maximizes sexual experiences, but there is no documentation of this physiological response. Hormone imbalances are not common side effects.

The home health nurse visits a patient at home and determines that the patient is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care? A. Ask the patient why he started taking illegal drugs B. Ask the patient about the amount of drug use and its effect C. Ask the patient how long he thought that he could take drugs without someone finding out D. Do not ask any questions for fear that the patient is in denial and will throw the nurse out of the home

B. Whenever the nurse carries out an assessment for a patient who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. A is incorrect because it is judgmental and off-focus, and reflects the nurse's bias. C is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. D is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention.

A 65-yr-old man is admitted to a mental health facility with a diagnosis of substance-induced persisting dementia resulting from chronic alcoholism. When conducting the admitting interview, the nurse determines that the patient is using confabulation. What does the nurse recall precipitates the patient's use of confabulation? A. Ideas of grandeur B. Need for attention C. Marked memory loss D. Difficulty in accepting the diagnosis

C. A patient with this disorder has a loss of memory and adapts by filling in areas that cannot be remembered with made-up information. Ideas of grandeur do not occur with this type of dementia. The use of confabulation is not attention-seeking behavior; the individual is attempting to mask memory loss. This person is not coping with the diagnosis; when confabulation, the individual is attempting to mask memory loss.

A young adult tells the nurse, "I have a new prescription for medical marijuana. I use it several times a day for my frequent muscle spasms." What information should the nurse provide first to this patient? A. Guidance that the prescription should not be shared with peers B. Directions to weigh self once a week and maintain a log of results C. Instructions about safety issues associated with driving or operating machinery D. Information about the potential for amotivational syndrome and memory problems

C. All of the options are correct, but safety is the nurse's first concern. Marijuana is a psychoactive substance. Effects include euphoria, sedation, perceptual distortions, and hallucinations; therefore driving or operating machinery may be hazardous.