22 - Substance-Related and Addictive Disorders (2) Flashcards
Erik is a 26-year-old patient who abuses heroin. He states to you, “I’ve been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want.” You know this describes:
a. ) intoxication.
b. ) tolerance.
c. ) withdrawal.
d. ) addiction.
b.) tolerance.
Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect.
Intoxication is the effect of the drug.
Withdrawal is a set of symptoms patients experience when they stop taking the drug.
Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.
Which of the following is true regarding substance addiction and medical comorbidity?
a. ) Most substance abusers do not have medical comorbidities.
b. ) There has been little research done regarding substance addiction disorders and medical comorbidity.
c. ) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
d. ) Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.
c.) Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders.
The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances.
Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody’s treatment plan while in the hospital?
a. ) Cody will return to a predrug level of functioning within 1 week.
b. ) Cody will be medically stabilized while in the hospital.
c. ) Cody will state within 3 days that he will totally abstain from drugs and alcohol.
d. ) Cody will take a leave of absence from college to alleviate stress.
b.) Cody will be medically stabilized while in the hospital.
If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated.
The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge.
The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.
The treatment team meets to discuss Cody’s plan of care. Which of the following factors will be priorities when planning interventions?
a. ) Readiness to change and support system
b. ) Current college performance
c. ) Financial ability
d. ) Availability of immediate family to come to meetings
a.) Readiness to change and support system
The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual’s cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient’s perceived need for change and having others who can lend support outside the hospital.
ody is preparing for discharge. He tells you, “Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?” Which response is appropriate teaching regarding naltrexone?
a. ) “It helps your mood so that you don’t feel the need to do drugs.”
b. ) “It will keep you from experiencing flashbacks.”
c. ) “It is a sedative that will help you sleep at night so you are more alert and able to make good decisions.”
d. ) “It helps prevent relapse by reducing drug cravings.”
d.) “It helps prevent relapse by reducing drug cravings.”
Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone.
When intervening with a patient who is intoxicated from alcohol, it is useful to first:
a. ) Let the patient sober up.
b. ) Decide immediately on care goals.
c. ) Ask what drugs other than alcohol the patient has recently used.
d. ) Gain adherence by sharing your personal drinking habits with the patient.
c.) Ask what drugs other than alcohol the patient has recently used.
You are caring for Mick, a 32-year-old patient with chemical addiction who will soon be preparing for discharge. A principle of counseling interventions that should be observed when caring for a patient with chemical addiction is to:
a. ) Praise the patient for compliant behavior.
b. ) Communicate that relapses are always possible.
c. ) Confirm that the patient’s recovery is considered complete after discharge.
e. ) Encourage Mick to resume his former friendships to regain a sense of normalcy.
b.) Communicate that relapses are always possible.
As you evaluate a patient’s progress, which treatment outcome would indicate a poor general prognosis for long-term recovery from substance abuse?
a. ) Patient demonstrates improved self-esteem.
b. ) Patient demonstrates enhanced coping abilities.
c. ) Patient demonstrates improved relationships with others.
d. ) Patient demonstrates positive expectations for ongoing drug use.
d.) Patient demonstrates positive expectations for ongoing drug use.
You are caring for Leah, a 26-year-old patient who has been abusing CNS stimulants. Which statement provides a basis for planning care for a patient who abuses CNS stimulants?
a. ) Symptoms of intoxication include dilation of the pupils, dryness of the oronasal cavity, and excessive motor activity.
b. ) Medical management focuses on removing the drugs from the body.
c. ) Withdrawal is simple and rarely complicated.
d. ) Postwithdrawal symptoms include fatigue and depression.
d.) Postwithdrawal symptoms include fatigue and depression.
The provision of optimal care for patients withdrawing from substances of abuse is facilitated by the nurse’s understanding that severe morbidity and mortality are often associated with withdrawal from:
a. ) Alcohol and CNS depressants.
b. ) CNS stimulants and hallucinogens.
c. ) Narcotic antagonists and caffeine.
d. ) Opiates and inhalants.
a.) Alcohol and CNS depressants.
