A patient has been diagnosed with alcoholism. The nurse tells him that he has a physical illness with a genetic predisposition to alcoholism and the only effective treatment is total abstinence from alcohol. This type of approach characterizes:
A. This question requires the test taker to differentiate among the theories and approaches commonly used with patients who are addicted.
The nurse explains that according to the intrapersonal theory, addiction is caused by early childhood rejection. These substance abusers are thought to have common characteristics that include:
B. The intrapersonal theory identifies the common personality traits of self-centeredness, need for control, and attention seeking as parts of the addictive personality.
To assess the amount of pain medication needed by the patient who has bone cancer, but who has also been using heroin, the best approach is to:
B. When trying to get a health history on a substance abuse patient, the best method is an open discussion of the drug use. The discussion should be open and nonjudgmental.
An alcoholic patient is brought to the inpatient psychiatric unit saying that he does not know where he is or what day it is. Because he has a heavy drinking history, you suspect that he is having:
B. Blackouts are common with heavy drinking over time. The patient data support that the memory loss is associated with the alcohol use, and blackouts would be an expected outcome.
The nurse is discharging a pulmonary patient home with her family. She has had a difficult time while in the hospital and experienced withdrawal from tobacco. When the nurse tells her that there are community resources to help her to stop smoking, she says, “That’s OK; I can stop whenever I want to.” This is an example of:
A. Denial is a common defense mechanism used by substance abusers.
A patient with an alcohol addiction says, “My drinking is all my wife’s fault. She makes me so crazy I just have to have a drink.” This is an example of:
C. The patient in the scenario is projecting. He is blaming his wife for his drinking problem rather than accepting that the drinking is his problem.
Substance abuse might be suspected in a patient who has:
C. Abnormal liver function tests and a GI bleed indicate substance abuse.
A urine drug screen is ordered for a patient suspected of a DWI. The nurse explains that drugs that are being screened for can include:
B. Has the correct combination of an illicit drug, an anxiolytic, and an opioid.
When an alcoholic patient brought in 12 hours ago in an intoxicated state begins to exhibit tremors and increased blood pressure and is agitated, the nurse assesses that the patient is in:
D. The signs of early withdrawal from alcohol are agitation and elevated vital signs. These warning signs usually occur 6 to 12 hours after the last drink.
The nurse is aware that the alcoholic patient is at risk for a syndrome related to thiamine deficiency, which is:
D. Wernicke’s encephalopathy is a vitamin B1 (thiamine) deficiency. If not treated with vitamin supplements, the condition can progress to a more serious form.
The wife of a long-term alcoholic wants to help her husband quit drinking. The nurse tells her that an initial approach might be for a group of friends and family to confront the patient with his alcoholism and tell him that:
D. The implementation for encouraging an alcoholic to go into treatment consists of a group of people telling the alcoholic that they think his drinking is destructive but they do not reject him as a person.
The nurse recommends to an alcoholic that he join Alcoholics Anonymous because this organization is:
D. Alcoholics Anonymous is a group of people who come together to offer support to each other to stay sober. It has a religious base, recognizes a higher power, and uses a 12-step approach to sobriety.
The nurse cautions a patient who is taking disulfiram (Antabuse) that ____ should be avoided.
C. Mouthwash contains alcohol and can trigger the effect of an Antabuse reaction. The alcoholic taking Antabuse needs to be aware of the hidden alcohol in some commonly used mouthwashes and other over-the-counter drugs.
The nurse on the admission unit is informed that a patient is being brought in who has been using “ice.” The nurse is aware that this patient may be:
D. Persons who use “ice,” a form of methamphetamine, are frequently violent while under the influence. The effect of ice can last as long as 12 to 14 hours.
In assisting with the development of a nursing care plan for a patient who has been using cocaine for 5 years, the nurse will include provisions to deal with:
D. Cocaine users can be depressed for as long as 2 years after quitting drug use. An antidepressant such as bupropion (Wellbutrin) is helpful in treating the depression.
Marijuana is a hallucinogenic that can be used for positive effects in the treatment of:
A. Marijuana has been studied for use for nausea and vomiting in cancer patients. Marinol (dronabinol) is a marijuana derivative currently available for use with cancer patients.
The nurse counsels a pregnant cocaine abuser that her cocaine use put the baby at risk for:
A. Babies born to mothers of cocaine addicts have a higher incidence of hyperactivity and neurologic problems.
Sometimes methadone is used in the treatment of heroin addiction. One reason that methadone is substituted for heroin is:
A. Methadone as an extended-release medication does not give the rush that addicts enjoy. It maintains the opioid level in the body but does so at a steady state and decreases cravings.
Narcan has been given to the heroin addict with respiratory depression. The nurse is alert for indications of:
D. Narcan is an opioid antagonist that causes the opioid to fall from receptor sites. When antagonist is given, the sudden loss of the opioid causes acute withdrawal to occur.
The treatment plans for alcohol abusers and drug abusers are similar—90 meetings in 90 days and 12-step programs. One difference is that:
A. One difference between alcohol and drug rehabilitation programs is that drug abusers will have a lower success rate. Alcohol abusers will have a higher rate of success when they follow the Alcoholics Anonymous program.
A nursing diagnosis that is appropriate for a patient with substance abuse is:
A. Low self-esteem is related to loss of control and guilt.
An implementation that can be used to help prevent relapse in a patient who has a substance abuse problem is:
A. Teaching these patients stress management will assist them in managing the conflict and stress in their daily lives that previously triggered substance abuse.
Older patients have a separate set of issues that affect their use of alcohol and other drugs. Some of these issues are all of the following except:
B. There is a higher rate of alcoholism in retirement communities because older adults are encouraged to drink at dinner and special occasions.
Substance abuse in adolescents can be a result of:
B. Peer pressure and wanting to feel part of the group are powerful motivators for adolescents. If the family is dysfunctional, there is added reinforcement to abuse drugs and frequent opportunities to abuse.
In some cases, patients will use drugs to treat the disturbing symptoms of psychiatric disease. This presents a problem, because there is the potential to:
C. Combining alcohol and psychiatric drugs, anxiolytics, or antidepressants may cause an accidental overdose by increasing the central nervous system (CNS) effects.
The nurse clarifies that when a urine sample is needed for screening in a case of DWI or other crime, the specimen should (select all that apply):
1. be collected and witnessed by a staff member of the same gender.
2. be documented with a “chain of custody” form, signed by all who handle the specimen.
3. be kept under secure conditions if temporary storage is necessary.
4. never be out of sight until someone from law enforcement takes it.
5. be placed in a specially marked container.
1, 2, 3
The specimen, if placed in secure storage, does not have to be in sight nor does it need a specially marked container.
The nurse documents signs of Wernicke’s encephalopathy in a patient with long-term alcoholism. These signs include (select all that apply):
The signs of Wernicke’s encephalopathy do not include projectile vomiting.a
The nurse explains that a test that can detect substance abuse for up to 1 year after only 2 or 3 days of use is done on ____________________.
Hair
The nurse explains that because the drug disulfiram (Antabuse) is deemed inappropriate, the patient has been put on the most reliable substitute, ____________________, which causes similar but less severe side effects in the alcoholic who continues to drink.