Question 1

A prescriber has ordered nicotine nasal spray for a patient to assist with smoking cessation. Which statement will the nurse include when teaching the patient about the medication?&#10;A) &#34;This will produce a steady level of nicotine to reduce your cravings.&#34;&#10;B) &#34;You should gradually reduce the dose after 3 months of use.&#34;&#10;C) &#34;You should use 1 spray in each nostril per dose up to 5 times per hour.&#34;&#10;D) &#34;You will not develop dependence on the nicotine in the nasal spray.&#34;

Accepted Answer

Dosing for the nicotine nasal spray should be 1 spray in each nostril once or twice an hour, up to 5 times per hour. The spray causes a rapid rise in blood nicotine levels with each dose, which more closely simulates smoking. After 4 to 6 weeks, dosing should be gradually reduced and then stopped. Many people become dependent on the spray.

Question 2

A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting and a weak, thready pulse of 120 beats per minute after ingesting several cigarettes at home. The nurse caring for this child will expect to provide which treatment?

A) Gastric lavage
B) Hemodialysis
C) Respiratory support
D) Vasoconstrictors

Respiratory support

Accepted Answer

Nicotine is highly toxic, and the most prominent symptoms are those involving the cardiovascular, GI, and central nervous systems. This child is showing signs of toxicity. Respiratory arrest can occur, because nicotine affects the muscles of respiration. Respiratory support is the key to management; no antidote is available to nicotine poisoning. Nicotine undergoes rapid metabolism, so recovery can occur in a few hours. Gastric lavage, hemodialysis, and vasoconstrictors are not recommended.

Question 3

A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient?

A) "These symptoms are common and will disappear over time."
B) "These symptoms may indicate an underlying psychiatric disorder."
C) "You may need an increased dose to overcome these symptoms of nicotine withdrawal."
D) "You should notify your provider of these symptoms immediately."

"You should notify your provider of these symptoms immediately."

Accepted Answer

Varenicline can cause serious neuropsychiatric effects, including mood swings, depression, and self-injurious behavior. Because suicidality is a risk, patients experiencing these effects should contact their provider immediately. The symptoms are not common and are not likely to abate. It is not known if these symptoms indicate an underlying disorder or if the drug causes the symptoms. Increasing the dose will increase the symptoms, since they are related to the drug.

Question 4

The spouse of a patient who smokes wonders why anyone would want to engage in &#34;such a disgusting habit.&#34; What will the nurse tell the spouse?&#10;A) Nicotine causes relaxation and helps with sleep.&#10;B) Nicotine increases alertness and promotes dopamine release.&#10;C) Nicotine lowers blood pressure.&#10;D) Nicotine settles the stomach and reduces nausea and vomiting.

Accepted Answer

Nicotine increases alertness, facilitates memory, and improves cognition. Even though users report feeling relaxed when using nicotine, it actually increases arousal and does not cause relaxation. Nicotine elevates blood pressure. Nicotine causes the gastrointestinal (GI) side effects of nausea, vomiting, and increased motility.

Question 5

A patient asks about nicotine patches for smoking cessation and wants to know the difference between the 24-hour patch and the 16-hour patch. Which response by the nurse is correct?&#10;A) &#34;The 16-hour patch is for patients who have trouble sleeping.&#34;&#10;B) &#34;The 16-hour patch simulates usual nicotine ingestion patterns.&#34;&#10;C) &#34;The 24-hour patch is for persons weighing more than 100 pounds.&#34;&#10;D) &#34;The 24-hour patch is recommended for heavier smokers.&#34;

Accepted Answer

Nicotine transdermal patches usually are packaged in systems, with progressively smaller doses of nicotine. The 16-hour patch is designed to be removed at bedtime; this simulates the usual nicotine dosing produced by smoking. It does not necessarily affect the ability to sleep. Individuals who weigh less than 100 lb are advised to use smaller patches. Heavier smokers are advised to begin with larger patches.

Question 6

A patient who has just found out she is pregnant tells the nurse she wants to quit smoking. She asks about pharmacologic aids to help her quit. The nurse is correct to tell her what?&#10;A) &#34;Nicotine replacement therapy is harmful, but it is safer than smoking, so it can be used.&#34;&#10;B) &#34;Psychosocial support is the only recommended treatment for smoking cessation during pregnancy.&#34;&#10;C) &#34;Varenicline [Chantix] is safe to use during pregnancy.&#34;&#10;D) &#34;You should try to taper off your smoking gradually, because none of the drugs are safe.&#34;

Accepted Answer

Because nicotine is a component of nicotine replacement therapy (NRT), NRT is not safe during pregnancy. However, it is safer than smoking, and if it can help the patient stop smoking, it is recommended with caution. Psychosocial support is more effective when combined with a first-line pharmacologic agent. Varenicline has been shown to have harmful effects on fetuses in animal testing, so it should be avoided during pregnancy. Tapering nicotine withdrawal only seems to prolong the withdrawal symptoms; abrupt cessation is better than a taper.

Question 7

A patient with a desire to stop smoking asks a nurse about nicotine chewing gum [Nicorette]. The patient currently smokes 30 cigarettes per day. Which statement by the nurse is correct?&#10;A) &#34;Stop using the gum 6 months after you stop using cigarettes.&#34;&#10;B) &#34;Use the 4-mg strength gum and chew one piece every 2 to 3 hours.&#34;&#10;C) &#34;Use the gum whenever you feel a craving for a cigarette.&#34;&#10;D) &#34;You should start with 30 pieces of the 2-mg strength gum per day.&#34;

Accepted Answer

Nicorette gum is available in two strengths, 2 and 4 mg. Patients who smoke more than 25 cigarettes per day should use the 4-mg strength. Dosing the gum on a regular schedule of every 2 to 3 hours has proved to be more effective than as-needed use. Use of the gum longer than 6 months total is not recommended, and the gum should be stopped 3 months after the last cigarette. PRN dosing is not as effective as regular dosing. The dose for a heavy smoker is 4-mg strength gum, one piece every 2 to 3 hours.

Question 8

A patient who wants to quit smoking has begun taking varenicline [Chantix]. The patient reports experiencing mood swings and depression and a desire to cause harm to herself. What will the nurse tell this patient?

A) "These symptoms are common and will disappear over time."
B) "These symptoms may indicate an underlying psychiatric disorder."
C) "You may need an increased dose to overcome these symptoms of nicotine withdrawal."
D) "You should notify your provider of these symptoms immediately."

Accepted Answer

Varenicline is a partial agonist at nicotinic receptors and helps block nicotine's access to these receptors. A common side effect is sleep disturbances. Buspirone is a smoking cessation agent that acts to reduce withdrawal side effects. Varenicline is not used to reduce addiction to the patch.

Question 9

A patient reports a desire to stop smoking and asks what is available without a prescription to help with smoking cessation. The nurse tells the patient that which method is best?&#10;A) Abrupt discontinuation to shorten withdrawal effects&#10;B) Nicotine replacement and 1-800-QUITNOW&#10;C) Nicotine replacement products tapered over a year&#10;D) Support groups without the use of medications

Accepted Answer

Nicotine addiction can be treated with pharmacologic agents or counseling, but the combination of these two approaches is more effective than either one alone. Abrupt cessation is better than tapering off, because the withdrawal effects are not so prolonged; however, this approach is not recommended as the best way to quit. Nicotine replacement products should be discontinued after a few weeks to months after quitting smoking, because they contain nicotine, which is both harmful and addicting. Support groups alone can work but are not as effective as the combination of support groups and medications.

Question 10

A nurse is conducting a smoking cessation class in the community and is discussing the physiologic effects of nicotine. The nurse is correct to teach that these effects include which of the following?&#10;A) Increased blood pressure&#10;B) Decreased gastric acid&#10;C) Vomiting&#10;D) Suppression of nausea&#10;E) Increased alertness&#10;F) Suppression of appetite

Accepted Answer

The physiologic effects of nicotine include increased blood pressure and other cardiovascular effects, vomiting, increased alertness, and suppression of appetite. Decreased gastric acid and suppression of nausea are not physiologic responses associated with nicotine use.

Deck 39: Drug Abuse III: Nicotine and Smoking