Substance, MDD, Culture

Question 1

What is Substance-Use Disorders?

Answer 1

Addiction
The need is so strong

Question 2

What is Substance-Induced Disorders?

Answer 2

Intoxication
Withdrawal

Question 3

Patient using substances
Tolerance

Answer 3

Need for increasing amount of the medication or substance is required to produce the desired effect
More, more, more and more!!

Question 4

What will occur when you abruptly stop drinking

a) How long till symptoms occur?
b) Symptoms

Answer 4

Alcohol withdrawal
a) 4 to 12 hours
b) Abnormal cramping, vomiting, shakes, insomnia, and anxiety.

Question 5

Interventions Alcohol withdrawal

a) Assess what is the prior to providing care?
b) What is the primary concern for AW?
c) Encourage attendance to what group?
d) For environment?

Answer 5

a) Nurse must self-assess their own feelings
b) Safety
c) 12 steps Self-help groups (AA)
d) Maintain a safe environment
low stimulation environment
Emotional support

Question 6

Medications used in alcohol withdrawal.

Answer 6

Benzodiazepines!!
chlordiazepoxide
carbamazepine
Clonidine

Question 7

What is Delirium tremens/ DTs?

Answer 7

The most severe form of ethanol withdrawal
Medical emergency!!!

Question 8

The signs and symptoms of DTs
alcohol withdrawal delirium

Occurs typically ?

Answer 8

On the 2-3 days of withdrawal

Severe shaking
Confusion
Hallucinations
Heard voices

Question 9

What is CAGE assessment instrument?

Answer 9

Substance Abuse Screening Tool

Cut down on your drinking?
Annoyed you by criticizing your drinking?
Guilty about your drinking?
Eye-opener

If the patient answers “yes” they get 1 point
if they answer “no” they get 0 points

Question 10

CAGE assessment
a) Score of 0-1?
b) Score of 2-3?

Answer 10

a) low risk of drinking problem
b) high suspicion of alcoholism

Question 11

What is the Wernicke’s encephalopathy?

Why it occur?

Answer 11

Lack of thiamine,brain damage
Caused by lack of vitamin B1
Treatment: thiamine replacement

Occurs d/t heavy alcohol consumption

Question 12

Wernicke’s encephalopathy
Signs and symptoms

Answer 12

Ataxia (loss of muscle coordination)
Diplopia(double vision)
Somnolence(drowsiness, desire to fall sleep)
Stupor(-unconsciousness)

Question 13

What is Korsakoff syndrome?

Answer 13

Memory disorder that results from lack of vitamin B1
Seen in clients recovering from Wernicke’s encephalopathy

Question 14

Korsakoff syndrome
Signs and symptoms

Answer 14

Inability to form new memories
Loss of memory
Making up stories (confabulation)

Question 15

What is withdrawal?

Answer 15

Physiological and mental readjustment of the discontinuation
Occurs abrupt, 4-12 hours

Question 16

What is Alcoholic hallucinosis?

Answer 16

Auditory hallucinations occur either during or after heavy alcohol consumption

Question 17

What is Blackout?

Answer 17

brief periods of amnesia(memory loss) that occur during or immediately following a period of drinking

Question 18

Peripheral Neuropathy?

Answer 18

Nerve damage result in pain
D/t lack of vitamins B (thiamine)
Treated by: abstinence from alcohol

*Paralysis can occur if pt doesn’t stop drinking

Question 19

Alcoholic myopathy?

Answer 19

Acute: sudden onset of muscle pain, swelling, weakness, elevated muscle enzymes
Chronic: gradual wasting and weakness in skeletal muscles – no pain or elevated muscle enzymes

D/t lack of vitamins B (thiamine)

Question 20

Priority nursing diagnosis in alcohol withdrawal? 5

Answer 20

Risk for injury
Denial
Ineffective Coping
Dysfunctional family process
Imbalanced nutrition less than body requirement

Question 21

Alcohol withdrawal
Denial

Answer 21

Commonly used
Conscious or unconscious attempt
“ I can quit whenever I want to”

Question 22

1. Which of the following has been implicated
   in the predisposition to substance abuse?
   A. Hereditary factor
   B. Fixation in the adolescent stage of
   psychosexual development
   C. Punitive ego
   D. Narcissistic and dependent personality traits

Answer 22

A
Especially evident with alcoholism
Children of alcoholics are 4 times more likely than other children to become alcoholic

hereditary 遺伝的な

Question 23

A client is brought to the emergency department.
The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician’s orders is thiamine. Which is the rationale for this intervention?

A. To prevent nutritional deficits
B. To prevent pancreatitis
C. To prevent alcoholic hepatitis
D. To prevent Wernicke’s encephalopathy

Answer 23

D
Wernicke’s encephalopathy is the most
serious form of thiamine deficiency in clients
diagnosed with alcoholism.
If thiamine replacement therapy is not
undertaken quickly, death will ensue.

Question 24

A client diagnosed with chronic alcoholism
and he wants to stop drinking. which medication would the nurse provide information?
A. Carbamazepine (Tegretol)
B. Clonidine (Catapres)
C. Disulfiram (Antabuse)
D. Folic acid (Folvite)

Answer 24

C

Disulfiram is used as a deterrent 抑止する to drinking.
Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort.

It is important that the patient understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.

Question 25

A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse to include in the presentation? a) Older adults require higher doses of a substance to achieve a desire effect b) Older adults commonly use rationalization to cope with substance use disorder. c) Older adults are at an increased risk for substance use following retirement. d) Older adults develop substance use to mask manifestations of dementia.

Answer 25

C Life style change stressors increase the risk for substance use b Daniel not rationalization 合理化

Question 26

A nurse is assessing a pt who has alcohol use disorder and is experiencing withdrawal. Which one is expecting finding? a) Bradycardia b) Fine tremors of both hands c) Hypotension d) Vomiting E) Restlessness

Answer 26

B, d, e Restlessness 落ち着きのなさ a Tachycardia c hypertension

Question 27

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following findings should the nurse identify as primary? a) Orient the client frequently to time, place, and person. b) Offer fluids and nourishing diet as tolerated. c) Implement seizure precautions d) Encourage participation in group therapy

Answer 27

c The greatest risk to the client is injury. a, b,c This is not primary intervention

Question 28

A nurse is caring for a client who has alcohol use disorder. The client no longer experiencing withdrawal. Which meds administering to assist the client with maintain abstinence from alcohol? a) Chlordiazepoxide b) Bupropion c) Disulfiram d) Carbamazepine

Answer 28

C a, d acute alcohol withdrawal b nicotine withdrawal

Question 29

A nurse is providing teaching to the family of a client who has substance use disorder. Which following statements by family indicate understand of teaching? a) " We need to understand that our sibling is responsible for their disorder" b) "Eliminating codependent behavior will promote recovery" c) "our sibling should participate in an AI-Anon group tp assist with recovery" d) "The primary goal of treatment is abstinence from substance use" e) "Our sibling needs to discuss personal feelings about substance use to help recovery"

Answer 29

b,d,e b　互いに強く依存 c Client must acknowledge their feelings a) they are not responsible for their disease but are responsible their recovery. c) Al-Anon is a recovery group for the family, rather than for a client.

Question 30

Major Depressive Disorder Symptoms

Answer 30

For at least 2 weeks At least five of the following clinical Suicidal thoughts Interest decreased Guilt Energy decreased Concentration decreased Depressed mood Difficulty sleeping or excessive sleeping No history of manic behavior

Question 31

MDD Acute phase

Answer 31

Sever clinical findings of depression Treatment 6 to 12 weeks They need hospitalized Asses suicide risk One-to-one observation as needed

Question 32

MDD Maintenance phase

Answer 32

Remission of manifestation This phase can last for years. Prevention of future episode Remission 治療の結果(時には無治療で)病気の勢いがゆるんだ(＝弱まった)状態を言う。

Question 33

MDD Continuation phase

Answer 33

Increase to ability to function Treatment 4-9 months relapse prevention through education, medication, therapy and goal treatment

Question 34

Major depressive disorder characterized by?

Answer 34

depressed mood

Question 35

An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent’s belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately? A. Post trauma syndrome related to parent’s death B. Anxiety (severe) related to parent’s death C. Coping, ineffective related to parent’s death D. Grieving, complicated related to parent’s death

Answer 35

D 悲しむ This symptoms are indicative of dysfunctional or complicated grieving

Question 36

When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? A. Strong or aged cheese should not be eaten while taking this group of medications. B. The full therapeutic potential of tricyclics may not be reached for 4 weeks. C. Long-term use may result in physical dependence. D. Tricyclics should not be given with anti-anxiety agents.

Answer 36

B

Question 37

A patient has been diagnosed with major depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching? A. Do not eat chocolate while taking this medication. B. The medication may cause priapism. C. The medication should not be discontinued abruptly. D. The medication may cause hotosensitivity

Answer 37

B Antidepressants, such as paroxetine, must be tapered and not stopped abruptly 持続勃起症

Question 38

Symptoms of alcohol withdrawal

Answer 38

abdominal cramps vomiting tremor of hands increase BP

Question 39

What medication most likely to take for alcohol withdraw?

Answer 39

Benzodiazepines!! chlordiazepoxide oxazepam lorazepam diazepam

Question 40

Alcohol use pattern phase 1 and 2?

Answer 40

Phase 1 Relieve everyday stress Enjoying drinking Phase 2 Begin with blackouts No longer a source of pleasure Secreting drinking

Question 41

Alcohol use pattern phase 3??

Answer 41

Lost control Extremally ill Loos of consciousness lose a job, marriage, family and friends

Question 42

Alcohol use pattern phase 4??

Answer 42

Emotional and physical disintegration 崩壊 Hallucinations, tremors, panic For long time heavy drinkers, abrupt withdrawal of alcohol can be fetal

Question 43

Priority interventions with caring for an American Indian elder

Answer 43

-Touch is not highly regarded a handshake may be viewed as aggressive - Some Native Americans will not touch a dead person - Avoid eye contact it is considered rude in their culture - Alcohol use disorder is most common psychiatric diagnosis Others high risks for illness include DM, TB, CVD, homicide, suicide, pneumonia, flu

Question 44

Negative aspects of cultural assumptions

Answer 44

Not to assume that all individuals who share a culture or ethnic group are identical =Stereotype Every individual must be appreciated for his or her uniqueness

Question 45

A patient with a bipolar disorder diagnosis is having religious delusions. How might the delusions impact the spiritual assessment? A. Delusional patients cannot participate in assessments. B. Religious delusions will have no impact on the spiritual assessment. C. Assessment findings cannot be relied upon. D. It may be difficult to differentiate from general religious beliefs.

Answer 45

D Approximately 15 percent of people with bipolar disorder have religious delusions. Sometimes these delusions can be difficult to differentiate from general religious or cultural beliefs.

Question 46

Which of the following statements indicate that love may be an important component of the healing process? A. Love increases the production of cortisol B. Love increases the inflammatory response C. Love increases the production of dopamine. D. Love increases the fight-or-flight response

Answer 46

C Love increases the production of norepinephrine and dopamine and may stave off depression.

Question 47

To assess for biological variations of a patient, which question should the nurse ask? A. “What do you do to keep well?” B. "Who purchases the food in your household?” C. "How do you deal with pain?” D. "What time do you usually eat your meals?”

Answer 47

B Nutritional preferences and deficiencies are a biological variation. Asking ”who purchases the food in your household?” is an assessment strategy used to determine biological variations. 生物学的変化

Question 48

“The blues” are a)_________responses to everyday disappointments in life.

Answer 48

a) normal, healthy If these occur then problem Adaptation is ineffective Symptoms impair functioning

Question 49

A client is widow of 6 months, she told her sister "doesn't have anything more to live for" she has been hospitalized MDD. What is the priority diagnosis? a) Imbalanced nutrition b) Complicated grieving c) Risk for suicide d) Social isolation

Answer 49

c

Question 50

The goal of cognitive behavior therapy with depressed clients is to a) Identify and change dysfunctional patterns of thinking b) Resolve the symptoms and initiate or restore adaptive family functioning c) Alter the neurotransmitters that are creating the depressed mood d) Provide feedback from peers who are having similar experience

Answer 50

a

Question 51

A client has just been admitted to the psych unit with MDD. Which behavioral manifestation might the nurse expect? a) Slumped posture b) Hallucinations c) Feeling of despair d) Appears to have boundless energy e) Anorexia

Answer 51

a,c,e Slumped posture　しゃがんだ姿勢 despair　絶望 Anorexia　拒食症 Either anorexia or bulimia nervosa boundless energy 無限のエネルギー

Question 52

A client with depression ask the nurse why would you be checking my thyroid function? a) An underactive thyroid gland can manifest as depression b) Depression has been proven to be hormonal illness c) Thyroid hormone replacement is a first line treatment

Answer 52

a An underactive thyroid gland is where your thyroid gland does not produce enough hormones

Question 53

An acutely depressed client isolates her self in her room. What a nurse should say? a) Do you like exercise? b) Come with me, I will go with you to group therapy c) Would you like to got group therapy, stay in bed. or come out to the day lounge? d) Why do you stay in your room al the time?

Answer 53

b

Question 54

A client whose husband died 6 month ago is given MDD. She said " I start feeling angry that he died and left me all alone. he should stopped smoking years ago! But then I start feeling guilty for feeling that" What is the appropriate response? a) Yes, he should stopped smoking. b) I can understand how you must feel c) Those feelings are a normal part of the grief response d) Just think about the good time tha you had with him

Answer 54

c

Question 55

Substance addiction relationship and sociality?

Answer 55

difficulty with interpersonal relationship Socially isolation

Question 56

Substance use disorder a)What % is a legal intoxication? b) What % is acute toxicity?

Answer 56

a) 0.08% (80g/dL) b) 0.4%(400d/dL)

Question 57

Medication Opioid overdose

Answer 57

Narcan Naltrexone Nalemfene

Question 58

Substance used disorder Individual therapy

Answer 58

Cognitive behavior therapy -relaxation or cognitive reframing -can be used decrease anxiety and change behavior

Question 59

Substance used disorder group therapy

Answer 59

A group who has similar diagnosis can meet in an outpatient setting or residential facilities

Question 60

Substance used disorder Family therapy

Answer 60

Family sometimes can act enabler Families learn about change that behavior Codependency 共依存 Enabler 助けてあげるつもりでやったことがかえって相手のためにならないようなことをする人

Question 61

What bupropion used for?

Answer 61

Nicotine withdrawl