Chapter 19: Addictions and Compulsions Flashcards
- A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?
a. Between 0800 and 1000 today (6 to 8 hours after drinking stopped)
b. Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)
c. About 0200 on hospital day 3 (72 hours after drinking stopped)
d. About 0200 on hospital day 4 (96 hours after drinking stopped)
ANS: B
Alcohol withdrawal usually begins 6 to 8 hours after cessation or significant reduction of alcohol intake. It peaks between 24 and 48 hours, then resolves or progresses to delirium.
- A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is:
a. jaundiced.
b. dependent on alcohol.
c. healthy but underweight.
d. microcephalic and cognitively impaired.
ANS: D
Fetal alcohol syndrome is the result of alcohols inhibiting fetal development in the first trimester. The fetus of a woman who drinks that much alcohol will probably have this disorder. Alcohol use during pregnancy is not likely to produce the findings listed in the distractors.
- A patient was admitted last night with a hip fracture sustained in a fall while intoxicated. The patient points to the Bucks traction and screams, Somebody tied me up with ropes. The patient is experiencing:
a. an illusion.
b. a delusion.
c. hallucinations.
d. hypnagogic phenomenon.
ANS: A
The patient is misinterpreting a sensory perception when seeing a noose instead of traction. Illusions are common in early withdrawal from alcohol. A delusion is a fixed, false belief. Hallucinations are sensory perceptions occurring in the absence of a stimulus. Hypnagogic phenomena are sensory disturbances that occur between waking and sleeping.
- A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, Snakes are crawling on my bed. Ive got to get out of here. What is the most accurate assessment of the situation? The patient:
a. is attempting to obtain attention by manipulating staff.
b. may have sustained a head injury before admission.
c. has symptoms of alcohol withdrawal delirium.
d. is having a recurrence of an acute psychosis.
ANS: C
Symptoms of agitation, elevated pulse, and perceptual distortions point to alcohol withdrawal delirium, a medical emergency. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.
- A patient admitted yesterday for injuries sustained in a fall while intoxicated believes snakes are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?
a. Disturbed sensory perception
b. Ineffective coping
c. Ineffective denial
d. Risk for injury
ANS: D
clouded sensorium, agitation, sensory perceptual distortions, and poor judgment increase the risk for injury. Disturbed sensory perception is an applicable diagnosis, but safety has a higher priority. The scenario does not provide data to support the other diagnoses.
- A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
a. Monoamine oxidase inhibitor, such as phenelzine (Nardil)
b. Phenothiazine, such as thioridazine (Mellaril)
c. Benzodiazepine, such as lorazepam (Ativan)
d. Narcotic analgesic, such as morphine
ANS: C
This patient is experiencing alcohol withdrawal delirium. Sedation allows for the safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties. Antidepressant, antipsychotic, and opioid medications will not relieve the patients symptoms.
- A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?
a. Check the patient every 15 minutes.
b. Rigorously encourage fluid intake.
c. Provide one-on-one supervision.
d. Keep the room dimly lit.
ANS: C
This patient is experiencing alcohol withdrawal delirium. One-on-one supervision is necessary to promote physical safety until sedation reduces the patients feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes illusions. Oral fluids are important, but safety is a higher priority.
- A patient with a history of daily alcohol abuse says, Drinking helps me cope with being a single parent. Which response by the nurse would help the individual conceptualize the drinking more objectively?
a. Sooner or later, alcohol will kill you. Then what will happen to your children?
b. I hear a lot of defensiveness in your voice. Do you really believe this?
c. If you were coping so well, why were you hospitalized again?
d. Tell me what happened the last time you drank.
ANS: D
The individual is rationalizing. The correct response will help the patient see alcohol as a cause of the problems, not the solution. This approach can also help the patient become receptive to the possibility of change. The incorrect responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurses frustration with the patient.
- A patient asks for information about Alcoholics Anonymous (AA). Which is the nurses best response?
a. It is a self-help group with the goal of sobriety.
b. It is a form of group therapy led by a psychiatrist.
c. It is a group that learns about drinking from a group leader.
d. It is a network that advocates strong punishment for drunk drivers.
ANS: A
AA is a peer support group for recovering alcoholics. The goal is to maintain sobriety. Neither professional nor peer leaders are appointed.
- Police bring a patient to the emergency department after an automobile accident. The patient is ataxic with slurred speech and mild confusion. The blood alcohol level is 400 mg/dl (0.40 mg %). Considering the relationship between behavior and blood alcohol level, which conclusion can the nurse draw? The patient:
a. rarely drinks alcohol.
b. has a high tolerance to alcohol.
c. has been treated with disulfiram (Antabuse).
d. has recently ingested both alcohol and sedative drugs.
ANS: B
A nontolerant drinker would be in a coma with a blood alcohol level of 400 mg/dl (0.40 mg %). The fact that the patient is walking and talking shows a discrepancy between blood alcohol level and expected behavior. It strongly suggests that the patients body has become tolerant to the drug. If disulfiram and alcohol are ingested together, then an entirely different clinical picture would result. The blood alcohol level gives no information about the ingestion of other drugs.
- A patient admitted to an alcoholism rehabilitation program says, Im just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and several drinks during the evening. The patient is using which defense mechanism?
a. Rationalization
b. Introjection
c. Projection
d. Denial
ANS: D
Minimizing ones drinking is a form of denial of alcoholism. The patients own description indicates that social drinking is not an accurate name for the behavior. Projection involves blaming another for ones faults or problems. Rationalization involves making excuses. Introjection involves taking a quality into ones own system.
- A new patient in an alcoholism rehabilitation program says, Im just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and a few drinks in the evening. Which response by the nurse will help the patient view the drinking more honestly?
a. I see, and use interested silence.
b. I think you may be drinking more than you report.
c. Being a social drinker involves having a drink or two once or twice a week.
d. You describe drinking steadily throughout the day and evening. Am I correct?
ANS: D
The answer summarizes and validates what the patient reported but is accepting rather than strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in treatment.
- During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, After discharge, Im sure everything will be just fine. Which remark by the nurse will be most helpful to the spouse?
a. It is good that youre supportive of your spouses sobriety and want to help maintain it.
b. Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol.
c. It will be important for you to structure life to avoid as much stress as possible. You will need to provide social protection.
d. Remember that alcoholism is a disorder of self-destruction. You will need to observe your spouses behavior carefully.
ANS: B
During recovery, patients identify and use alternative coping mechanisms to reduce their reliance on alcohol. Physical adaptations must occur. Emotional responses, formerly dulled by alcohol, are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who should be given anticipatory guidance and accurate information.
- The treatment team plans care for a person diagnosed with schizophrenia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning?
a. Consider each disorder primary and provide simultaneous treatment.
b. The person will benefit from treatment in a residential treatment facility.
c. Withdraw the person from cannabis, and then treat the schizophrenia.
d. Treat the schizophrenia first, and then establish the goals for the treatment of substance abuse.
ANS: A Dual diagnosis (co-occurring disorders) clinical practice guidelines for both outpatient and inpatient settings suggest that the substance disorder and the psychiatric disorder should both be considered primary and receive simultaneous treatments. Residential treatment may or may not be effective.
- When working with a patient beginning treatment for alcohol abuse, what is the nurses most therapeutic approach?
a. Empathetic, supportive
b. Strong, confrontational
c. Skeptical, guarded
d. Cool, distant
ANS: A
Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.
- A patient comes to an outpatient appointment obviously intoxicated. The nurse should:
a. explore the patients reasons for drinking today.
b. arrange admission to an inpatient psychiatric unit.
c. coordinate emergency admission to a detoxification unit.
d. tell the patient, We cannot see you today because youve been drinking.
ANS: D
One cannot conduct meaningful therapy with an intoxicated patient. The patient should be taken home to recover and then make another appointment. Hospitalization is not necessary.
- When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After one year of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?
a. Tolerance develops.
b. The alcohol is less potent.
c. Antagonistic effects occur.
d. Hypomagnesemia develops.
ANS: A
Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects would account for this change.
- Which statement most accurately describes substance addiction?
a. It is a lack of control over use. Tolerance, craving, and withdrawal symptoms occur when intake is reduced or stopped.
b. It occurs when psychoactive drug use interferes with the action of competing neurotransmitters.
c. Symptoms occur when two or more drugs that affect the central nervous system (CNS) have additive effects.
d. It involves using a combination of substances to weaken or inhibit the effect of another drug.
ANS: A
Addiction involves a lack of control over substance use, as well as tolerance, craving, and withdrawal symptoms when intake is reduced or stopped.
- A patient who was admitted for a heroin overdose received naloxone (Narcan), which improved the breathing pattern. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, I feel terrible. Which analysis is correct?
a. The patient is exhibiting a prodromal symptom of seizures.
b. An idiosyncratic reaction to naloxone is occurring.
c. Symptoms of opiate withdrawal are present.
d. The patient is experiencing a relapse.
ANS: C
The symptoms given in the question are consistent with narcotic withdrawal and result from administration of naloxone. Early symptoms of narcotic withdrawal are flulike in nature. Seizures are more commonly observed in alcohol withdrawal syndrome.
- In the emergency department, a patients vital signs are: blood pressure (BP), 66/40 mm Hg; pulse (P), 140 beats per minute (bpm); and respirations (R), 8 breaths per minute and shallow. The patient overdosed on illegally obtained hydromorphone (Dilaudid). Select the priority outcome.
a. Within 8 hours, vital signs will stabilize as evidenced by BP greater than 90/60 mm Hg, P less than 100 bpm, and respirations at or above 12 breaths per minute.
b. The patient will be able to describe a plan for home care and achieve a drug-free state before being released from the emergency department.
c. The patient will attend daily meetings of Narcotics Anonymous within 1 week of beginning treatment.
d. The patient will identify two community resources for the treatment of substance abuse by discharge.
ANS: A
Hydromorphone (Dilaudid) is an opiate drug. The correct answer is the only one that relates to the patients physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The distractors are desired outcomes later in the plan of care.
- Select the nursing intervention necessary after administering naloxone (Narcan) to a patient experiencing an opiate overdose.
a. Monitor the airway and vital signs every 15 minutes.
b. Insert a nasogastric tube and test gastric pH.
c. Treat hyperpyrexia with cooling measures.
d. Insert an indwelling urinary catheter.
ANS: A
Narcotic antagonists such as naloxone quickly reverse CNS depression; however, because the narcotics have a longer duration of action than antagonists, the patient may lapse into unconsciousness or require respiratory support again. The incorrect options are measures unrelated to naloxone use.
- A nurse worked at a hospital for several months, resigned, and then took a position at another hospital. In the new position, the nurse often volunteers to be the medication nurse. After several serious medication errors, an investigation reveals that the nurse was diverting patient narcotics for self-use. What early indicator of the nurses drug use was evident?
a. Accepting responsibility for medication errors.
b. Seeking to be assigned as a medication nurse.
c. Frequent complaints of physical pain.
d. High sociability with peers.
ANS: B
The nurse intent on diverting drugs for personal use often attempts to isolate him- or herself from peers rather than being sociable. The person seeks access to medications. Usually, the person will blame errors on others rather than accepting responsibility.
- A nurse with a history of narcotic abuse is found unconscious in the hospital locker room after overdosing. The nurse is transferred to an inpatient substance abuse unit for care. Which attitudes or behaviors by nursing staff may be enabling?
a. Conveying understanding that pressures associated with nursing practice underlie substance abuse.
b. Pointing out that work problems are the result, but not the cause, of substance abuse.
c. Conveying empathy when the nurse discusses fears of disciplinary action by the state board of nursing.
d. Providing health teaching about stress management.
ANS: A
Enabling denies the seriousness of the patients problem or supports the patient as he or she shifts responsibility from self to circumstances. The incorrect options are therapeutic and appropriate.
- Which treatment approach is most appropriate for a patient with antisocial tendencies who has been treated several times for substance addiction but has relapsed?
a. One-week detoxification program
b. Long-term outpatient therapy
c. Twelve-step self-help program
d. Residential program
ANS: D
Residential programs and therapeutic communities have goals of complete change in lifestyle, abstinence from drugs, elimination of criminal behaviors, development of employable skills, self-reliance, and honesty. Residential programs are more effective than outpatient programs for patients with antisocial tendencies.