chap 43: Smoking Cessation

Question 1

1. Nicotine withdrawal symptoms include:
2. Nervousness
3. Increased appetite
4. Difficulty concentrating
5. All of the above

Answer 1

4. All of the above

Question 2

2. If a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient:
3. Smokes more than 10 cigarettes a day
4. Smokes within 30 minutes of awakening in the morning
5. Smokes when drinking alcohol
6. All of the above

Answer 2

2. Smokes within 30 minutes of awakening in the morning

Question 3

3. Instructions for a patient who is starting nicotine replacement therapy include:
4. Smoke less than 10 cigarettes a day when starting nicotine replacement.
5. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco.
6. Nicotine replacement can be used indefinitely.
7. Nicotine replacement therapy is generally safe for all patients.

Answer 3

2. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco.

Question 4

4. Nicotine replacement therapy should not be used in which patients?
5. Pregnant women
6. Patients with worsening angina pectoris
7. Patients who have just suffered an acute myocardial infarction
8. All of the above

Answer 4

4. All of the above

Question 5

5. Instructions for the use of nicotine gum include:
6. Chew the gum quickly to get a peak effect.
7. The gum should be “parked” in the buccal space between chewing.
8. Acidic drinks such as coffee help with the absorption of the nicotine.
9. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings.

Answer 5

2. The gum should be “parked” in the buccal space between chewing.

Question 6

6. Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed:
7. Chew the lozenge well.
8. Drink at least 8 ounces of water after the lozenge dissolves.
9. Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of 20 per day).
10. A tingling sensation in the mouth should be reported to the provider.

Answer 6

3. Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of 20 per day).

Question 7

7. Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation because:
8. The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.
9. There is the ability to “fine tune” the amount of nicotine that is delivered to the patient at any one time.
10. There is less of a problem with nicotine toxicity than other forms of nicotine replacement.
11. Transdermal nicotine is safer in pregnancy.

Answer 7

1. The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.

Question 8

8. The most common adverse effect of the transdermal nicotine replacement patch is:
9. Nicotine toxicity
10. Tingling at the site of patch application
11. Skin irritation under the patch site
12. Life-threatening dysrhythmias

Answer 8

3. Skin irritation under the patch site

Question 9

9. If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch and:
10. Wash the area thoroughly with soap and water.
11. Flush the area with clear water.
12. Reapply a new patch in 8 hours.
13. Take acetaminophen for the headache associated with toxicity.

Answer 9

2. Flush the area with clear water.

Question 10

10. When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include:
11. Inhale deeply with each dose to ensure deposition in the lungs.
12. The dose is one to two sprays in each nostril per hour, not to exceed 40 sprays per day.
13. If they have a sensation of “head rush” this indicates the medication is working well.
14. Nicotine spray may be used for up to 12 continuous months.

Answer 10

2. The dose is one to two sprays in each nostril per hour, not to exceed 40 sprays per day.

Question 11

11. If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include:
12. Bupropion (Zyban) is started 1 to 2 weeks before the quit date.
13. Nicotine replacement products should not be used with bupropion.
14. If they smoke when taking bupropion they may have increased anxiety and insomnia.
15. Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy.

Answer 11

1. Bupropion (Zyban) is started 1 to 2 weeks before the quit date.

Question 12

12. Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:
13. The maximum time varenicline can be used is 12 weeks.
14. Nausea is a sign of varenicline toxicity and should be reported to the provider.
15. The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date.
16. Neuropsychiatric symptoms may occur.

Answer 12

4. Neuropsychiatric symptoms may occur.

Question 13

13. The most appropriate smoking cessation prescription for pregnant women is:
14. A nicotine replacement patch at the lowest dose available
15. Bupropion (Zyban)
16. Varenicline (Chantix)
17. Nonpharmacologic measures

Answer 13

4. Nonpharmacologic measures