22 - Substance-Related and Addictive Disorders

Question 1

A syndrome that occurs after stopping the long-term use of a drug is called

a. ) amnesia.
b. ) tolerance.
c. ) enabling.
d. ) withdrawal.

Answer 1

d.) withdrawal.

Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage.

Question 2

The only class of commonly abused drugs that has a specific antidote is the

a. ) opiates.
b. ) hallucinogens.
c. ) amphetamines.
d. ) benzodiazepines.

Answer 2

a.) opiates.

The effects of opiates can be negated by a narcotic antagonist such as naloxone.

Question 3

The term tolerance, as it relates to substance abuse, refers to

a. ) the 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.

Answer 3

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

With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect.

Question 4

Benzodiazepines are useful for treating alcohol withdrawal because they

a. ) block cortisol secretion.
b. ) increase dopamine release.
c. ) decrease serotonin availability.
d. ) exert a calming effect.

Answer 4

d.) exert a calming effect.

Benzodiazepines act by binding to α-aminobutyric acid–benzodiazepine receptor sites, producing a calming effect.

Question 5

A person who covertly supports the substance-abusing behavior of another is called a(n)

a. ) patsy.
b. ) enabler.
c. ) participant.
d. ) minimizer.

Answer 5

b.) enabler.

An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use.

Question 6

A client who is dependent on alcohol tells the nurse, “Alcohol is no problem for 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.

Answer 6

a.) denial.

Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence).

Question 7

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is 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.

Answer 7

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

If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators.

However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager’s major concerns are with job performance and client safety.

Reporting an impaired colleague is not easy, even though it is our responsibility. To not “see” what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug.

Question 8

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested

a. ) LAAM
b. ) GHB
c. ) ReVia
d. ) Clonidine

Answer 8

b.) GHB

The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, “roofies”), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners.

These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render 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.

Question 9

In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery?

a. ) Ongoing support from at least two family members must be secured.
b. ) The client needs to be employed.
c. ) The client must strive to maintain abstinence.
d. ) A regular schedule of appointments with a primary care provider must be set up.

Answer 9

c.) The client must strive 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.

Question 10

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.

Answer 10

a.) lacrimation, rhinorrhea, dilated pupils, and muscle aches.

Symptoms of opioid withdrawal resemble the “flu”; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.

Question 11

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

Answer 11

c.) Barbiturates

Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death.

Question 12

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.

Answer 12

a.) tremors.

Tremors are an early sign of alcohol withdrawal.

Question 13

A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, 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.

Answer 13

d.) observation for hyperpyrexia and seizures.

Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose.

Question 14

Which assessment data would be most consistent with a severe 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

Answer 14

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

Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.

Question 15

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

Answer 15

b.) Stimulation and anesthetic effects

Cocaine exerts two main effects on the body, both anesthetic and stimulant.

Question 16

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.

Answer 16

c.) abstain from the use of mood-altering substances.

Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term.

Question 17

A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol 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. ) The client’s blood alcohol level is within legal limits.

Answer 17

a.) The client has a high tolerance to alcohol.

A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level.

Question 18

A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. 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.

Answer 18

b.) 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.

Question 19

A teaching need is revealed when a client taking disulfiram (Antabuse) states,

a. ) “I usually treat heartburn with antacids.”
b. ) “I take ibuprofen or acetaminophen for headache.”
c. ) “Most over-the-counter cough syrups are safe for me to use.”
d. ) “I have had to give up using aftershave lotion.”

Answer 19

c.) “Most over-the-counter cough syrups are safe for me to use.”

The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol.

Question 20

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.

Answer 20

c.) result from lack of good situational support.

Relapses can point out problems to be resolved and can result in renewed efforts for change.