The nurse is caring for four patients. Which patient should be seen first, based upon substance-abuse risk potential?
B. Male patient of Native American descent
Males are diagnosed with substance abuse concerns at higher rates than females and are twice as likely to meet criteria for a drug use disorder. When compared to other ethnic groups in the general U.S. population, Native Americans and Alaskan Natives have the highest prevalence of alcohol dependence and are more likely to have used illicit substances.
Which patient behaviors should the nurse suspect as related to alcohol withdrawal?
D. Hyper alert state, jerky movements, easily startled
Patients who are exhibiting hyper alertness, jerky movements, and are startled easily are most likely in a state of alcohol withdrawal, a condition which peaks in 24 to 48 hours after cessation or reduction of alcohol intake and then rapidly and dramatically disappears unless the withdrawal process progresses to alcohol withdrawal delirium.
Tachycardia, diaphoresis, elevated blood pressure, peripheral vascular collapse, electrolyte imbalance, paranoid delusions, fever, and fluctuating levels of consciousness are associated with alcohol withdrawal delirium, a condition that is considered a medical emergency and can result in deathif not treated.
The only class of commonly abused drugs that has a specific antidote is
D. opiates.
The effects of opiates can be negated by a narcotic antagonist such as naloxone aka. Narcan.
Benzodiazepines are useful for treating alcohol withdrawal because they
C. bind to ã-aminobutyric acid–benzodiazepine receptors.
Benzodiazepines act by binding to ã-aminobutyric acid–benzodiazepine receptor sites and produce a calming effect. Text page: 426
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
C. denial.
Believing one can control drug use despite addiction to the substance is based on denial (escaping unpleasant reality by ignoring its existence).Text page: 407
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?
D. GHB
The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam(Rohypnol, "roofies"), a fast-acting benzodiazepine, and ã-hydroxybutyrate (It should read gamma(γ)-hydroxybutyrate)(GHB) and its congeners. They are odorless, tasteless, and colorless, mix easily with drinks, and can leave a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. Text page: 417
While helping an addicted individual plan for ongoing treatment, which of the following interventions is the first priority for a safe recovery?
B. The client strives to maintain abstinence.
Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability. Text page: 420
Symptoms that would signal opioid withdrawal include
B. lacrimation, rhinorrhea, dilated pupils, and muscle aches.
lacrimation - tears
Symptoms of opioid withdrawal resemble the "flu," with runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever. Text page: 414
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?
B. Barbiturates
Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death. Text page: 410
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. Correct observation for hyperpyrexia and seizures.
Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. Text page: 413
T/F: Opiate overdose results in lowered blood pressure with a drop in pulse rate along with respiratory depression.
False: rise in pulse
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.
A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. Text page: 412
0.05 mg% 1-2 drinks Changes in mood and behavior; impaired judgment
0.10 mg% 5-6 drinks Clumsiness involuntary motor activity; legal level of intoxication in most states
0.20 mg% 10-12 drinks Depressed function of entire motor area of the brain, causing staggering and ataxia (failure of muscular coordination); emotional liability
0.30 mg% 15-18 drinks Confusion, stupor
0.40 mg% 20-24 drinks coma
0.50 mg% 25-30 drinks Deathdue to respiratory depression
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. obtaining an order for seclusion and close observation.
Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off.
Talking down is never advised because of the client's unpredictable violent potential.
Naltrexone is an opiate antagonist. Text page: 415
A teaching need is revealed when a client taking disulfiram states
C. "Most over-the-counter cough syrups are OK for me to use."
The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol. Text page: 426
The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses
B. result from lack of good situational support.
Relapses can point out problems to be resolved and can result in renewed efforts for change. Text Page: 424
Addiction is
a chronic relapsing condition.
Relapse is one of the criteria for Dx of addiction.
Signs of Alcohol poisoning
Inability to arouse individual
Cool or clammy skin
Respirations less than 10 per minute
Cyanosis under fingernails or gums
emesis while semiconscious or unconscious
Treatment of Alcohol poisoning
or any CNS depressant: barbiturates, benzodiazepines, etc.
Carefully titrated detoxification with similar drug, e.g. alcohol for alcohol
% of nurses that abuse alcohol or drugs
% of nurses whose abuse seriosly affects their ability to provide safe nursing care