Substance/Addictive Disorders

1. A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response.

a. "The goal of AA is for members to learn controlled drinking with the support of a higher power."
b. "An individual is supported by peers while striving for abstinence one day at a time."
c. "You must make a commitment to permanently abstain from alcohol and other drugs."
d. "You will be assigned a sponsor who will plan your treatment program."

b. "An individual is supported by peers while striving for abstinence one day at a time."

Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA.

2. A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed:
0200: 118/78 mm Hg and 72 beats/min
0400: 126/80 mm Hg and 76 beats/min
0600: 128/82 mm Hg and 72 beats/min
0800: 132/88 mm Hg and 80 beats/min
1000: 148/94 mm Hg and 96 beats/min
What is the nurse's priority action?

a. Force fluids.
b. Consult the health care provider.
c. Obtain a clean-catch urine sample.
d. Place the patient in a vest-type restraint.

b. Consult the health care provider.

Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention.

3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority?

a. Cardiovascular
b. Respiratory
c. Neurologic
d. Hepatic

b. Respiratory

Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers

4. A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient:

a. is attempting to obtain attention by manipulating staff.
b. may have sustained a head injury before admission.
c. has symptoms of alcohol-withdrawal delirium
d. is having an acute psychosis.

c. has symptoms of alcohol-withdrawal delirium

Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium

A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?

a. Disturbed sensory perception
b. Ineffective coping
c. Ineffective denial
d. Risk for injury

d. Risk for injury

The patient's clouded sensorium, sensory-perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority

6. A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n):

a. narcotic analgesic, such as hydromorphone
b. sedative, such as lorazepam or chlordiazepoxide
c. antipsychotic, such as olanzapine or thioridazine
d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

b. sedative, such as lorazepam or chlordiazepoxide

Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice because of their high therapeutic safety index and anticonvulsant properties.

7. A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated?

a. Check the patient every 15 minutes
b. One-on-one supervision
c. Keep the room dimly lit
d. Force fluids

b. One-on-one supervision

One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror

8. A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively?

a. "Sooner or later, alcohol will kill you. Then what will happen to your children?"
b. "I hear a lot of defensiveness in your voice. Do you really believe this?"
c. "If you were coping so well, why were you hospitalized again?"
d. "Tell me what happened the last time you drank."

d. "Tell me what happened the last time you drank."

will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change

9. A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. "Alcoholics Anonymous is a:

a. form of group therapy led by a psychiatrist."
b. self-help group for which the goal is sobriety."
c. group that learns about drinking from a group leader."
d. network that advocates strong punishment for drunk drivers."

ANS: B

Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient:

a. rarely drinks alcohol.
b. has a high tolerance to alcohol.
c. has been treated with disulfiram (Antabuse).
d. has ingested both alcohol and sedative drugs recently.

B. has a high tolerance to alcohol.

A non-tolerant drinker would be in coma with a blood alcohol level of 500 mg%. The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant. The blood alcohol level gives no information about ingestion of other drugs.

A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism?

a. Denial
b. Projection
c. Introjection
d. Rationalization

a. Denial

Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker.

Projection involves blaming another for one's faults or problems.

Rationalization involves making excuses.

Introjection involves incorporating a quality of another person/group into one's own personality.

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?

a. Bromocriptine
b. Methadone
c. Disulfiram
d. Naltrexone

d. Naltrexone

useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse?

a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."
b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection."
c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully."
d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."

During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should:

a. provide long-term care for the patient in a residential facility.
b. withdraw the patient from cannabis, then treat the schizophrenia.
c. consider each diagnosis primary and provide simultaneous treatment
d. first treat the schizophrenia, then establish goals for substance abuse treatment.

c. consider each diagnosis primary and provide simultaneous treatment

Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction.

a. Empathetic, supportive
b. Skeptical, guarded
c. Cool, distant
d. Confrontational

a. Empathetic, supportive

Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest

16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose?

a. Simple and safe
b. Active and bright
c. Stimulating and colorful
d. Confrontational and challenging

a. Simple and safe

Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation

When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred?

a. Tolerance has developed.
b. Antagonistic effects are evident.
c. Metabolism of the alcohol is now delayed.
d. Pharmacokinetics of the alcohol have changed.

a. Tolerance has developed

Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as:

a. codependence
b. assertiveness
c. role reversal
d. homeostasis.

a. codependence

Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. Often by taking responsibility for their actions or consequences. In this case, the spouse taking sick leave to cover for their partner's drinking behavior exemplifies codependent behavior

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome.

a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization.
b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.
c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department.
d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response.

a. "Alcoholism is a lifelong disease. Relapses are expected."
b. "Use search and destroy tactics to keep the home alcohol free."
c. "It's important that you visit your family member on a regular basis."
d. "Make your loved one responsible for the consequences of behavior."

d. "Make your loved one responsible for the consequences of behavior."

Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process.

Which goal for treatment of alcoholism should the nurse address first?

a. Learn about addiction and recovery.
b. Develop alternate coping strategies.
c. Develop a peer support system.
d. Achieve physiologic stability

d. Achieve physiologic stability

The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.

A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate?

a. 1-week detoxification program
b. Long-term outpatient therapy
c. 12-step self-help program
d. Residential program

d. Residential program

Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, be self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.

a. Monitor vital signs.
b. Observe for depression.
c. Awaken the patient every 15 minutes.
d. Use warmers to maintain body temperature.

ANS: A

Overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

Symptoms of withdrawal from opioids for which the nurse should assess include:

a. dilated pupils, tachycardia, elevated blood pressure, and elation.
b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.
c. mood lability, incoordination, fever, and drowsiness.
d. excessive eating, constipation, and headache.

b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.

The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis.

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes:

a. cross-tolerance.
b. substance abuse
c. substance addiction.
d. substance intoxication

c. substance addiction

Nicotine meets the criteria for a "substance," the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose

Which assessment findings are likely for an individual who recently injected heroin?

a. Anxiety, restlessness, paranoid delusions
b. Muscle aching, dilated pupils, tachycardia
c. Heightened sexuality, insomnia, euphoria
d. Drowsiness, constricted pupils, slurred speech

d. Drowsiness, constricted pupils, slurred speech

Heroin (opiate) - CNS depressant. Blood pressure, pulse, and respiration will be decreased, and attention will be impaired

An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect:

a. a schizophrenic episode.
b. hallucinogen ingestion.
c. opium intoxication.
d. cocaine overdose.

b. hallucinogen ingestion.

The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going "crazy."

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information?

a. Substance Abuse and Mental Health Services Administration (SAMHSA)
b. Institute of Medicine - National Research Council (IOM)
c. National Council of State Boards of Nursing (NCSBN)
d. American Society of Addictions Medicine

ANS: A

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely?

a. PCP
b. Heroin
c. Barbiturates
d. Amphetamines

d. Amphetamines

symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation

Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will:

a. state, "I know I need long-term treatment."
b. use denial and rationalization in healthy ways.
c. identify constructive outlets for expression of anger.
d. develop a trusting relationship with one staff member.

a. state, "I know I need long-term treatment."

The key refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action?

a. Perform a thorough assessment of the patient.
b. Verify that security services are immediately available.
c. Self-assess personal attitude, values, and beliefs about this health problem.
d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

c. Self-assess personal attitude, values, and beliefs about this health problem.

The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one's own perspective. Negative feelings may occur for the nurse

1. A patient undergoing alcohol rehabilitation decides to begin disulfiram therapy. Patient teaching should include the need to: (select all that apply)

a. avoid aged cheeses.
b. avoid alcohol-based skin products.
c. read labels of all liquid medications.
d. wear sunscreen and avoid bright sunlight.
e. maintain an adequate dietary intake of sodium.
f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F

The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions.

The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply)

a. rehearsing techniques to handle anticipated stressful situations.
b. advising the patient to accept residential treatment if relapse occurs.
c. assisting the patient to identify life skills needed for effective coping.
d. advising isolating self from significant others until sobriety is established.
e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

ANS: A, C, E

Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role-playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes.

3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply)

a. administration of naloxone (Narcan).
b. vitamin B12 and folate supplements.
c. restoring nutritional integrity.
d. management of heart rate.
e. environmental safety.

d. management of heart rate.
e. environmental safety.

Care of patients who have taken bath salts is similar to those who have used stimulants. Tachycardia and chest pain are common when a patient has used bath salts. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behavior and/or paranoia; therefore, safety is a priority concern.

A new patient beginning an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Select the nurse's most therapeutic responses. Select all that apply.

a. "I see," and use interested silence.
b. "I think you are drinking more than you report."
c. "Social drinkers have one or two drinks, once or twice a week."
d. "You describe drinking steadily throughout the day and evening."
e. "Your comments show denial of the seriousness of your problem."

c. "Social drinkers have one or two drinks, once or twice a week."
d. "You describe drinking steadily throughout the day and evening."

summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

Which of the following statements most accurately describes the concept of tolerance?
A. A person needs increasing amounts of a substance to achieve a desired effect.
B. A person develops over time a psychological dependence on a substance.
C. A person uses greater amounts of a substance for longer periods than he/she intended.
D. A person has frequent periods of unsuccessfully trying to stop using the substance.

A. A person needs increasing amounts of a substance to achieve a desired effect.

Which of the following medications is frequently used to detoxify a client in alcohol withdrawal?
A. Diazepam
B. Haloperidol
C. Clonidine
D. Sertaline

A. Diazepam


Side note:
haloperidol - schizophrenia
Clonidine - HTN as well as ADHD (monotherapy) and adjunctive therapy to stimulant medications
sertraline - MDD, OCD, Panic Disorder, PTSD, and Social Anxiety Disorder

All of the following substances are considered central nervous system stimulants, except
A. cocaine
B. caffeine
C. methadone
D. methamphetamine

C. methadone

Detoxification protocols have been developed and implemented for all of the following substances, except
A. alcohol
B. opioids
C. cannabinoids
D. nicotine

C. cannabinoids

Which of the following complications of substance abuse is considered life threatening?
A. Drug craving
B. Hallucinogen flashbacks
C. Delirium tremens
D. Opioid withdrawal

C. Delirium tremens

Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food. Symptoms include:
Seizures (may occur without other symptoms of DTs;common in first 12 - 48 hours after last drink)
Body tremors
Changes in mental function
Agitation, irritability
Confusion, disorientation
Hallucinations
Symptoms of alcohol withdrawal

A syndrome that occurs after stopping use of a drug is
A. amnesia.
B. tolerance.
C. enabling.
D. withdrawal.

D. withdrawal.

The only class of commonly abused drugs that has a specific antidote is
A. opiates.
B. hallucinogens.
C. amphetamines.
D. benzodiazepines.

A. opiates

The term tolerance, as it relates to substance abuse, refers to
A. use of a substance beyond acceptable societal norms.
B. the additive effects achieved by taking two drugs with similar actions.
C. the signs and symptoms that occur when an addictive substance is withheld.
D. the need to take larger amounts of a substance to achieve the same effects.

D. the need to take larger amounts of a substance to achieve the same effects.

Benzodiazepines are useful for treating alcohol withdrawal because they
A. block cortisol secretion.
B. increase dopamine release.
C. decrease serotonin availability.
D. bind to ã-aminobutyric acid-benzodiazepine receptors.

D. bind to ã-aminobutyric acid-benzodiazepine receptors

A person who covertly supports the substance-abusing behavior of another is called a(n)
A. patsy.
B. enabler.
C. participant.
D. minimizer.

B. enabler

A client who is dependent on alcohol and drinks several six-packs of beer daily tells the nurse "Alcohol is no problem to me. I can quit anytime I want to." The nurse can assess this statement as indicating
A. denial.
B. projection.
C. rationalization.
D. reaction formation.

A. denial.

What is the ethical obligation of the nurse who has seen a peer divert a narcotic compared with the ethical obligation when the nurse observes a peer to be under the influence of alcohol?
A. The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place.
B. Neither should be reported until the nurse has collected factual evidence.
C. No report should be made until suspicions are confirmed by a second staff member.
D. Supervisory staff should be informed as soon as possible in both cases.

D. Supervisory staff should be informed as soon as possible in both cases.

Which drug is most apt to have been ingested by a young woman who comes to the emergency department with the report that although she has no recollection of the incident, she believes she was sexually assaulted at a party?
A. LAAM
B. GHB
C. ReVia
D. Clonidine

B. GHB

While helping an addicted individual plan for ongoing treatment, which of the following interventions is the first priority for a safe recovery?
A. Securing ongoing support from at least two family members.
B. The client needs to be employed.
C. The client strives to maintain abstinence.
D. A regular schedule of appointments with a primary care provider.

C. The client strives to maintain abstinence.

Symptoms that would signal opioid withdrawal include
A. lacrimation, rhinorrhea, dilated pupils, and muscle aches.
B. illusions, disorientation, tachycardia, and tremors.
C. fatigue, lethargy, sleepiness, and convulsions.
D. synesthesia, depersonalization, and hallucinations.

A. lacrimation, rhinorrhea, dilated pupils, and muscle aches.

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support?
A. Opiates
B. Marijuana
C. Barbiturates
D. Hallucinogens

C. Barbiturates

Barbiturate withdrawal is dangerous and can result in severe symptoms such as seizures, delirium, and cardiovascular collapse, requiring medical intervention and nursing support

Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of
A. tremors.
B. seizures.
C. blackouts.
D. hallucinations.

A. tremors.

A client has been using cocaine intranasally for 4 years. Two months ago she started freebasing. For the past week she has locked herself in her apartment and has used $8000 worth of cocaine. When brought to the hospital she was unconscious. Nursing measures should include
A. induction of vomiting.
B. administration of ammonium chloride.
C. monitoring of opiate withdrawal symptoms.
D. observation for hyperpyrexia and seizures.

D. observation for hyperpyrexia and seizures.

An unconscious client is admitted to the emergency department. The admitting diagnosis is "rule out opiate overdose." Which item of assessment data would be most consistent with opiate overdose?
A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min
B. Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min
C. Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min
D. Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min

Cocaine exerts which of the following effects on a client?
A. Stimulation after 15 to 20 minutes
B. Stimulation and anesthetic effects
C. Immediate imbalance of emotions
D. Paranoia

B. Stimulation and anesthetic effects

Cocaine is a stimulant drug that increases dopamine levels in the brain, leading to heightened alertness, energy, and euphoria. It also has local anesthetic effects, which can numb tissue.

An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will
A. discuss the addiction with significant others.
B. state an intention to stop using illegal substances.
C. abstain from the use of mood-altering substances.
D. substitute a less-addicting drug for the present drug.

C. abstain from the use of mood-altering substances.

A client was in an automobile accident. Although he has the odor of alcohol on his breath, his speech is clear and he is alert and answers questions posed to him. The law enforcement officer requests that the emergency department staff draw a blood sample for blood alcohol level determination. The level is determined to be 0.30 mg%. What conclusion can be drawn?
A. The client has a high tolerance to alcohol.
B. The client ate a high-fat meal before drinking.
C. The client has a decreased tolerance to alcohol.
D. No conclusions can be drawn from the data.

A. The client has a high tolerance to alcohol.

A client brought to the emergency department at the university hospital after PCP ingestion tries to run up and down the hallway. The nursing intervention that would be most therapeutic is
A. taking him to the gym on the psychiatric unit.
B. obtaining an order for seclusion and close observation.
C. assigning a psychiatric technician to "talk him down."
D. administering naltrexone as needed per hospital protocol.

B. obtaining an order for seclusion and close observation.

A teaching need is revealed when a client taking disulfiram states
A. "I usually treat heartburn with antacids."
B. "I take ibuprofen or acetaminophen for headache."
C. "Most over-the-counter cough syrups are OK for me to use."
D. "I have had to give up using aftershave lotion."

C. "Most over-the-counter cough syrups are OK for me to use."

It works by causing unpleasant reactions when alcohol is consumed. One important teaching points is to avoid alcohol in all forms, including OTC products (cough syrups) which may contain alcohol.

The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses
A. are an indicator of treatment failure.
B. are caused by physiological changes.
C. result from lack of good situational support.
D. can be learning situations to prolong sobriety.

C. result from lack of good situational support

Naltrexone

• decreases pleasure, prevent relapse

• use after abstinence for 5 - 7 days

• Binds to opioid receptors & decs pleasure association w/ drinking and cravings for alcohol

• Must avoid opiates in all forms

Acamprosate

• decrease cravings

• restore brain balance GABA system

• Improves sleep which promotes recovery and abstinence (insomnia strongly associated w/ relapse)

• Not addictive

Disulfiram

• Increase side effects associated with alcohol

• Massive projectile vomiting as soon as they drink or sniff alcohol

• Inhibits dehydrogenase; relapse prevention

• Avoid: Alc swabs when drawing blood, alc mouthwashes, stains, fumes, paint, cough meds, vinegar can cause vomit reactions! Read labels!

• Cardiac disease, pregnancy, psychosis, impulsivity, and suicide risk

Methadone

• Synthetic opioid use for withdrawal & maintenance tx of heroin addiction

• Dispensed once daily from licensed “Methadone clinic”

• Decs withdrawal sx and blocks some of euphoria associated w/stronger opioids (heroin, morphine) and prevents relapse

Buprenorphine

• Partial opiate agonist/antagonist used for withdrawal & maintenance tx of opioid addiction

• Binds to opiate receptor & decs withdrawal/cravings while blocking most (but not all) of euphoria & resp depression associated w/ opioid use

Naltrexone (Opioid Use Disorder)

• Opioid antagonist that blocks effects alcohol, pain meds, and heroin

• Prevents opioid relapse by blocking euphoric and sedative effects of opiates

• no abuse potential

Naloxone

Treats opioid OD and rapidly reverses respiratory depression but quickly induces withdrawal sx