CH 8: Drugs in substance use disorder

The nurse is teaching a group in the community about substance use disorder. Which statement by the nurse is correct?

a. “Cravings always disappear after long periods of abstinence by the person addicted to drugs.”

b. “Abuse and dependence are synonymous terms, describing reliance on illicit substances.”

c. “Substance use disorder occurs when recurrent use causes clinically and functionally significant impairment.”

d. “Excessive caffeine use is a classic example of substance use disorder.”

ANS: C
Substance use disorder occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairments. Cravings may diminish after long abstinence but do not disappear completely. The terms “abuse” and “dependence” are no longer recommended for use due to the violence and stigma associated with the term “abuse” and the ambiguity of the term “dependence.” Excessive caffeine use is not considered a substance use disorder.

The nurse is caring for a patient under treatment for alcohol intoxication. The nurse notes that the patient’s serum alcohol level is 400 mg/dL. The patient is awake and conversational even though this is a potentially lethal dose. The nurse recognizes this as alcohol

a. withdrawal syndrome.

b. dependence.

c. craving.

d. tolerance.

ANS: D
Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-naïve person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Withdrawal syndrome describes a group of symptoms that occur upon cessation or reduction of use of a drug that has been used repeatedly. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Craving refers to a strong desire for a drug or for the intoxicating effects of that drug.

*What does the nurse understand must occur in order to produce withdrawal syndrome?

a. Intoxication

b. Craving

c. Drug tolerance

d. Prolonged or repeated use

ANS: D
Patients who use a drug repeatedly, usually for a prolonged period and/or in high doses, may experience withdrawal syndrome when the drug is stopped. Intoxication is a condition that results in disturbances in the level of consciousness, cognition, perception, judgment, behavior, and other psycho-physiologic functions. Cravings are a strong desire for a drug or for its intoxicating effects. Tolerance refers to a decrease in drug effects with repeated use.

The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct?

a. “Bupropion (Zyban) is effective and does not have any serious adverse effects.”

b. “Nicotine replacement therapies are effective and eliminate the need for behavioral therapy.”

c. “Varenicline (Chantix) may be used short-term for 1 to 2 months.”

d. You may experience headaches, irritability, and increased appetite for several months after stopping smoking.”

ANS: D
Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but can cause a variety of side effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 3 months.

Which of the following is NOT generally considered a side effect of nicotine replacement?
a. Tachycardia
b. Dizziness
c. Somnolence
d. Dyspepsia

ANS: C
Tachycardia, dizziness, and dyspepsia are side effects that can occur with nicotine replacement therapies. Nicotine replacement therapy is also associated with insomnia. Somnolence is not considered a common side effect of nicotine replacement products.

*The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking?

a. “I don’t smoke around my children or inside the house.”

b. “I want to stop smoking, but I will need help to do it.”

c. “I will quit so my coworkers will stop harassing me about it.”

d. “If I cut down gradually, I should be able to quit.”

ANS: B
Patients exhibit readiness when they state a desire to quit along with a request for professional assistance. Other factors discussed, such as children or coworkers, do not necessarily indicate a desire to quit.

*A patient is brought to the emergency department by a family member. The patient reports symptoms of paranoia and believes they are being followed. The patient presents with an elevated body temperature, elevated pulse, and high blood pressure. The nurse suspects that this patient has taken which of the following drugs?

a. Alcohol
b. Cocaine
c. Heroin
d. Oxycodone

ANS: B
A stimulant psychosis can occur with cocaine use, and can present as symptoms of paranoia such as believing they are being followed or someone is trying to attack them. Cocaine users will also present with elevations in temperature, pulse, and blood pressure. These are not physical signs typically seen with substance use disorder involving alcohol, heroin or oxycodone.

*The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug?
a. Alcohol
b. Cocaine
c. LSD
d. Methamphetamine

ANS: D
Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay (“meth mouth”) and dermatologic deterioration.

The nurse is teaching a patient who has completed detoxification for alcohol use disorder who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching?

a. “Even use of mouthwash can cause serious adverse effects while I am taking this drug.”

b. “If I use this medication, I won’t have to worry about participating in psychotherapy or counseling.”

c. “It is safe to take a product containing alcohol one week after the last dose of disulfiram.”

d. “This drug acts by blocking the pleasurable effects of alcohol.”

ANS: A

Disulfiram causes an unpleasant reaction if alcohol is consumed while taking the drug and can even occur with topical products containing alcohol and use of mouthwash. For disulfiram to be effective, persons with alcohol use disorder also need to participate in behavior modification, psychotherapy, and counseling. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol.

*A patient with a long history of alcohol use disorder is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate the possible need to give which of the following intramuscularly?

a. Dopamine to restore blood pressure

b. Fluid boluses to treat dehydration

c. Glucose to prevent hypoglycemia

d. Thiamine to treat nutritional deficiency

ANS: D
Thiamine is often given to people with alcohol use disorder to prevent neurologic damage (Wernicke encephalopathy). Other treatments are given as indicated based on patient presentation and needs.

*A nurse is giving a presentation on substance use disorder and is asked for examples of medications that are FDA-approved for maintenance treatment in people with alcohol use disorder (AUD). The nurse knows that all of the following are FDA-approved for the management of AUD, EXCEPT:

a. methadone
b. disulfiram
c. acamprosate
d. naltrexone

ANS: A
Disulfiram, acamprosate, and naltrexone are all approved by the FDA to treat UAD. Methadone is used in the management of opioid use disorder.

A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of substance use in the patient’s home. The nurse suspects that this patient is likely experiencing an overdose of which substance?

a. Alcohol
b. LSD
c. an opioid
d. methamphetamine

ANS: C
Opioid overdose is characterized by constricted pupils and respiratory depression.

A patient is brought to the emergency department after ingesting an overdose of an opioid medication several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action?

a. Administer disulfiram.

b. Administer flumazenil (Romazicon).

c. Administer naloxone (Narcan).

d. Administer IM thiamine.

ANS: C
Naloxone is the drug of choice in the treatment of respiratory depression associated with opioid overdose. Flumazenil is the antidote for benzodiazepine overdose. Disulfiram is used for the treatment of alcohol use disorder (AUD). Administration of thiamine is recommended in patients with AUD to prevent neurological damage associated with thiamine deficiency.

*Cough and cold products are also used for substance abuse. Which of the following contains the two most commonly misused cough and cold products?

a. Dextromethorphan and promethazine-codeine

b. Dextromethorphan and phenylephrine

c. Promethazine-codeine and phenylephrine

d. Dextromethorphan and guaifenesin

ANS: A
The two most frequently misused cough and cold products are dextromethorphan and promethazine-codeine cough syrup.

The nurse is teaching a patient who will be discharged home with naltrexone after treatment for opioid use disorder. What information will the nurse include in the teaching for this patient?

a. “This drug will eliminate your cravings.”

b. “You may take this drug once weekly.”

c. “Naltrexone blocks the pleasurable effects of opioids.”

d. “If you discontinue this drug abruptly, you will likely experience withdrawal symptoms.”

ANS: C
Naltrexone acts by blocking the pleasurable effects of opioids. Naltrexone is used in patients who are abstinent. It can precipitate withdrawal when given to patients currently using opioids, but abrupt discontinuation in a patient not currently taking opioids will not result in withdrawal symptoms. This drug does not control cravings, and it is taken once daily orally or as a monthly injection.