This exam practice guide has been created from the Test Bank For Halter Varcarolis' Foundations Of Psychiatric-Mental Health Nursing-Sherpath For Mental Health Nursing, 8th Edition.
Chapter 22
The nurse suspects a patient of substance abuse. What should be the nurse’s first intervention?
An assessment for substance use and comorbidities
A nurse is learning how to manage patients with substance with substance abuse disorders. Which step should the nurse apply as first line intervention in such cases?
Providing safety and sleep.
On examination, the nurse finds that a patient who is a drug addict has nasal damage. Which substance abuse does the nurse suspect?
Cocaine
The nurse cares for a patient with chronic pain. A regular dose of analgesic medication is ineffective in reducing the patient’s pain. What does the nurse expect is the cause for the patient’s response?
The patient is showing signs of tolerance.
What term is used to identify a syndrome that occurs after stopping the long-term use of a drug?
Withdrawal
Rationale
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. Amnesia, tolerance, and enabling are not used to identify the described event.
The nurse is learning about commonly abused substances and their effects. Which type of drug does the nurse understand to cause increased mental alertness?
Stimulants
Which chemical in tobacco causes addiction?
Nicotine
The term tolerance, as it relates to substance abuse, refers to?
The need to take larger amounts of a substance to achieve the same effects
What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with ethical obligation when the nurse observes a peer who is under the influence of alcohol?
Supervisory staff should be informed as soon as possible in both cases.
What is occurring in the patient with a substance abuse disorder who no longer responds to the effects of the substance?
Tolerance
Which finding indicates that treatment for imbalanced nutrition has been effective for a patient with a history of cannabis abuse?
Related study material: Research Paper for Substance Use Disorder Treatment Approaches
The patient eats a well-balanced diet.
The treatment team meets to discuss the plan of care for a patient diagnosed with addiction to heroin. Which factor will have priority when planning interventions?
Readiness to change
A patient is diagnosed with mouth cancer. Which substance abuse should the nurse inquire about with the patient?
Tobacco
A nurse is educating a group of adolescents about different kinds of substance abuse. In which category can magic mushrooms be classified?
Hallucinogens.
A patient describes experiences of having blackouts. The nurse suspects abuse of
Alcohol
A patient is administered naloxone for an opioid overdose. What withdrawal symptoms does the nurse anticipate? Select all that apply.
Yawning
Rhinorrhea
Lacrimation
Piloerection
Rationale. Withdrawal symptoms the nurse can anticipate include rhinorrhea, yawning, lacrimation, and piloerection. Nystagmus occurs in patients experiencing phencyclidine intoxication.
The nurse planning educational materials for parents of children with a history of opioid abuse will emphasize which signs when discussing opioid withdrawal? Select all that apply
-Sweating
-Runny nose
-Sleeplessness
-Enlarged pupils
Rationale. Signs of opioid withdrawal include dilated pupils, insomnia, diaphoresis, and rhinorrhea. Slurred speech is associated with opioid intoxication.
The nurse assesses a patient who abuses various substances and discovers significant dental problems. The nurse expects that this patient abuses which substance?
Methamphetamines
Rationale. Abuse of methamphetamine is associated with severe dental problems. If opiates are injected, damage to the skin and veins occurs. Alcohol abuse is associated with gastrointestinal erosion as well as other physiologic consequences. Abuse of inhalants is damaging to the respiratory tract.
In confidence, an emergency department nurse said to a nursing colleague, "I know I am addicted to narcotics but I'm afraid I will lose my nursing license if I talk to my supervisor about it." Select the colleague's best initial response.
"There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor."
Which response is appropriate when teaching a patient regarding a prescription for naltrexone?
It helps prevent relapse by reducing your drug cravings.
When caring for a patient who is intoxicated from alcohol, which need has the highest priority?
Safety and security.
The nurse is caring for a woman with chronic alcohol intoxication. The woman is prescribed disulfiram to treat the condition. Which information given by the nurse is appropriate about disulfiram?
You may experience adverse effects if you consume alcohol.
What is the nurse’s most important intervention when caring for a patient experiencing severe alcohol withdrawal symptoms?
Administer prescribed anticonvulsant medication.
The nurse is assessing a patient who has been smoking cigarettes for 5 years and has slowly increased the number of cigarettes consumed per day. What does the nurse recognize this condition as?
Tolerance
Rationale: Tolerance occurs when a person needs increased quantities of a substance to obtain the desired effect, thereby increasing the total intake of a substance. Addiction is caused by a disturbance in the regulation of the pleasure-seeking pathway of the brain leading to the need for an increased dose of the same substance for relief. Withdrawal occurs when a person experiences physiologic symptoms as a result of a decrease of the substance in the bloodstream. Intoxication occurs when a person uses a substance in excess.
A 19 year old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be a priority outcome for this patient’s treatment plan while in the hospital?
Patient will be medically stabilized while in the hospital.
What symptoms suggest the use of marijuana by a patient?
Increased heart rate and appetite
Rationale: A patient who has been using marijuana will have an increased heart rate and appetite. People who use marijuana often get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from gamma-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD).
A patient presents to the clinic stating, I don’t feel good, I think I drank too much coffee and my heart feels like it is pounding.
Muscle twitching
The nurse can anticipate muscle twitching during the assessment of the patient. Caffeine intoxication is characterized by several physical and behavioral symptoms. A behavioral symptom associated with caffeine intoxication is agitation. Tachypnea is not a typical finding in patients experiencing caffeine intoxication. Restlessness is another behavioral symptom of caffeine intoxication.
Which medication prescribed to a patient or treatment of alcohol addiction may be associated
Disulfiram
Rationale: Disulfiram (Antabuse) is used for the maintenance of alcohol abstinence. However, the medication should be taken consistently to maintain the alcohol aversion. Alcohol consumption while on disulfiram (Antabuse) leads to a toxic reaction that results in symptoms such as intense nausea, vomiting, respiratory difficulty, and mental confusion. Chlordiazepoxide (Librium) is used to reduce withdrawal agitation and can cause sedation and seizures. Phenobarbital (Phenobarbital) could result in sedation. Acamprosate calcium (Campral) causes side effects such as itching, diarrhea, and intestinal gas.
An appropriate long-term goal/outcome for a recovering substance abuser would be that the patient will
Abstain from the use of mood-altering substances
A patient has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, the nursing measures should include
Observation for cardiac dysfunction
Cardiac dysfunctions are observed in patients experiencing central nervous system stimulant overdose.
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
Gamma- hydroxybutyrate (GHB)
Commonly Exam Tested Substance-Related and Addictive Disorders
Substance Use Disorders (SUDs)
- Opioid use disorder
- Alcohol use disorder
- Nicotine addiction
- Cocaine use disorder
- Cannabis use disorder
- Methamphetamine use disorder
- Hallucinogen use disorder (e.g., LSD, magic mushrooms)
- Inhalant abuse
- Caffeine intoxication
- Polysubstance abuse
- Tolerance (as a physiological adaptation)
- Withdrawal syndrome
Mental and Behavioral Disorders
- Amnesia (associated with blackouts or GHB ingestion)
- Suicidal ideation
- Psychosis (associated with amphetamines)
- Disorientation and memory loss (associated with GHB)
- Hallucinations (associated with LSD)
- Agitation and restlessness (from caffeine intoxication)
Physical and Medical Conditions Linked to Substance Use
- Mouth cancer (linked to tobacco use)
- Nasal damage (from cocaine use)
- Dental problems (from methamphetamine use, aka "meth mouth")
- Gastrointestinal erosion (linked to alcohol abuse)
- Skin and vein damage (from injected opioids)
- Respiratory damage (from inhalants)
- Increased heart rate and appetite (from marijuana use)
- Muscle twitching (from caffeine intoxication)
- Cardiac dysfunction (from cocaine overdose)
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