Question 1

A psychiatric nurse is caring for a drug-addicted patient. The nurse knows that the ideal goal of drug rehabilitation for this patient is:&#10;A) abstinence from the drug.&#10;B) decreasing episodes of relapse.&#10;C) minimizing drug cravings.&#10;D) reduction of drug use.

Accepted Answer

The goal of treatment is complete cessation of the drug. Decreasing episodes of relapse,minimizing cravings,and reducing drug use are all steps toward achieving eventual abstinence.

Question 2

A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect that what has occurred?

A) Addiction
B) Compulsive drug seeking
C) Cross-tolerance
D) Drug tolerance

Drug tolerance

Accepted Answer

Patients who use a drug regularly develop tolerance to the drug when a dose produces a smaller response than it did initially. This patient has been on large doses of opioids for several weeks and has developed tolerance to this class of drugs. Addiction is characterized by compulsive drug seeking,which has not occurred. A patient using narcotics for severe pain is not a compulsive drug seeker. Cross-tolerance occurs when tolerance to one drug confers tolerance to another drug. The opioid analgesic for home use is in the same drug classification,so this is not cross-tolerance.

Question 3

A nurse is teaching a group of nursing students about drug abuse. Which statement by a student indicates a need for further teaching?&#10;A) &#34;Patients who experience physical dependence will show compulsive drug-seeking behavior.&#34;&#10;B) &#34;People who are addicted to a drug do not necessarily have tolerance to that drug.&#34;&#10;C) &#34;Physical dependence means that abstinence syndrome will occur if a drug is withdrawn.&#34;&#10;D) &#34;Physical dependence often contributes to addictive behavior but does not cause it.&#34;

Accepted Answer

Physical dependence occurs with prolonged drug exposure and,through neuroadaptive processes,results in abstinence syndrome if a drug is withdrawn. It does not necessarily result in compulsive drug-seeking behavior. Patients can have drug addiction,which involves compulsive drug seeking without having developed a tolerance to drug effects. Addictive behavior is the result of psychologic dependence with an intense subjective need for a drug. Because abstinence syndrome is uncomfortable,physical dependence can increase subjective feelings for a drug.

Question 4

A nursing student is caring for a patient who is addicted to several drugs. The student tells the nurse that the patient &#34;got this way on purpose.&#34; Which response by the nurse is most appropriate?&#10;A) &#34;Peer pressure and social factors determine individual choices.&#34;&#10;B) &#34;Physical dependence is necessary for addiction to occur.&#34;&#10;C) &#34;Preexisting psychopathology underlies most drug abuse.&#34;&#10;D) &#34;Some individuals are more vulnerable to drug abuse than others.&#34;

Accepted Answer

Some individuals are more prone to becoming drug abusers than others for a variety of reasons,including physiologic,psychologic,social,emotional,and genetic reasons. Peer pressure,social factors,the development of physical dependence,and underlying psychologic disorders contribute to the development of addiction but are not determining factors.

Question 5

A patient who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The patient reports feeling anxious and jittery. The nurse understands that this response is due to:

A) addiction.
B) psychologic dependence.
C) tolerance.
D) withdrawal syndrome.

Accepted Answer

Withdrawal syndrome occurs when patients have developed a physical dependence on a drug and then often show symptoms that are the opposite of the drug's effect when the drug is withdrawn. Addiction is characterized by compulsive drug seeking. Psychologic dependence is an intense subjective need for a drug. Tolerance develops when increased amounts of a drug are needed to achieve the drug's effects.

Question 6

A nurse is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching?&#10;A) &#34;Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits.&#34;&#10;B) &#34;Neural remodeling leads to decreased dopamine release, leaving users with feelings of lifelessness and depression.&#34;&#10;C) &#34;Over time, the brain will develop reduced responses to many addictive drugs.&#34;&#10;D) &#34;With the use of a drug over time, the brain undergoes synaptic remodeling.&#34;

Accepted Answer

Drugs of addiction use the same reward circuits that are used to reward biologically critical behaviors such as eating and sexual intercourse. However,addictive drugs lead to dopamine release that can be 2 to 10 times higher than that released naturally. Eventually,neural remodeling occurs,causing the brain to produce less dopamine and to reduce the number of dopamine receptors,leaving addicts feeling depressed and lifeless. This process of down-regulation reduces the response to the drug. All of this is part of the synaptic remodeling that occurs when the brain is exposed to a drug over a period of time.

Question 7

The nurse is teaching a nursing student about management of controlled substances in medication administration. Which statement by the nursing student indicates understanding of the teaching?&#10;A) &#34;If there is a difference between state and federal laws governing a scheduled drug, the federal law takes precedence.&#34;&#10;B) &#34;Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills.&#34;&#10;C) &#34;Schedule I drugs may only be given to hospitalized patients.&#34;&#10;D) &#34;To reduce the possibility of abuse of a drug that is Schedule II, the prescriber should call the prescription to the pharmacy.&#34;

Accepted Answer

Providers may prescribe Schedule III and IV drugs orally by phone,written as a prescription,or electronically,and may provide up to 5 refills. When state and federal laws differ,the more restrictive law takes precedence,whether it is the state or the federal law. Schedule I drugs have no approved uses. Schedule II drugs must be typed or written in indelible ink or pencil and signed by the provider or may be submitted electronically. They may be called in an emergency but must be followed by a written prescription within 72 hours.

Question 8

A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder?&#10;A) A college student who reports having experimented with marijuana in the past year&#10;B) An older adult patient with terminal cancer who requires twice the normal dose of morphine for pain relief&#10;C) A patient in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due&#10;D) A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain

Accepted Answer

Patients who use narcotics for minor pains are more likely to be compulsive drug seekers. A college student who experiments with an illegal substance is not necessarily going to develop a substance use disorder. An elderly patient with terminal cancer pain has most likely developed physical dependence and tolerance to morphine but is not a substance abuser. Patients with significant pain who ask for more frequent dosing are not showing substance use disorder.

Deck 37: Drug Abuse I: Basic Considerations