Question 1

A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which potential effect about the drug?

Accepted Answer

Naltrexone's effect is unknown. Reports from successfully treated clients suggest three kinds of effects: (1) can reduce craving (the urge or desire to drink), (2) can help maintain abstinence, and (3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink. The medication is not known to cause itching, euphoria, nor improved appetite.

Question 2

A 57-year-old client with a long history of alcohol dependence is being treated for alcoholism and is in the second week as an inpatient on the psychiatric unit. The client, a retired nurse, is observed wearing a hospital gown with a stethoscope. When asked about the stethoscope, the client replies that the nursing supervisor came to visit and said to wear it "so I'd remember to get well." What does the nurse suspect that the client may be experiencing?

Accepted Answer

Korsakoff's amnestic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation, (i.e., telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Wernicke's encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. Delirium tremens is an acute withdrawal syndrome characterized by autonomic hyperarousal, disorientation, hallucinations, and tremors. Malignant hyperthermia is characterized by a sharp increase in body temperature leading to muscle breakdown, kidney and cardiovascular failure, and death.

Question 3

A nurse is using motivational therapy with a client in treatment for alcohol dependency after being arrested for DUI. The client, who is unwilling to consider changing the established drinking behavior, emphatically states, "I am not an alcoholic; you can't make me stop drinking." Which response by the nurse would be most appropriate?

Accepted Answer

Motivational interviewing is a method of therapeutic intervention that seeks to elicit self-motivational statements from clients, which creates a disconnect between the clients' goals and their continued alcohol and substance use disorder. The acronym FRAMES (which is short form for feedback, responsibility, advice, menu of strategies, empathy, and self-efficacy) summarizes elements of brief interventions with clients using motivational interviewing. The nurse should emphasize both the client's freedom to choose to change as well as the client's responsibility to change. Telling the client to stop drinking and driving is confrontational and not therapeutic in this situation; telling the client to think about consequences to the marriage is inappropriate because the client has yet to acknowledge having a problem. Telling the client "You are not an alcoholic" only reinforces the client's denial.

Question 4

A 52-year-old client with a history of alcohol dependence is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6° above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?

Accepted Answer

The client is experiencing alcohol withdrawal and protecting the client from injury is the priority at this time. Although the client may be coping ineffectively or denying the alcoholism, the client's physical safety is a top priority. There is no indication to suggest that the client's thought processes are disturbed.

Question 5

A nurse is working with a client who has been diagnosed with a heroin dependency. The nurse engages in harm reduction by educating the client about which aspect?

Accepted Answer

Harm reduction initiatives range from widely accepted designated driver campaigns to controversial initiatives such as provision of condoms in schools, safe injection rooms, needle exchange programs, and heroin maintenance programs. Problem solving, coping skills, and naltrexone would not be considered harm-reduction interventions.

Question 6

A 20-year-old client arrives at the emergency department by ambulance. The client is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on the client's arms. The friend who came with the client reports that the client had just "shot up" heroin and then became unconscious. Which medication would the nurse most likely expect to administer?

Accepted Answer

Naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension. Naltrexone is used to treat alcohol dependence. Bupropion and varenicline are used to promote smoking cessation.

Question 7

A client receiving methadone maintenance therapy has been given information about this treatment. The nurse determines that the education was successful when the client makes which statement?

Accepted Answer

A client receiving methadone maintenance therapy may experience nausea. Therefore, the client should eat small, frequent meals to treat the nausea and loss of appetite and should take the drug with food and lie quietly to minimize the nausea. Alcohol should be avoided. Constipation may occur, necessitating the use of a mild laxative.

Question 8

A client with a history of alcohol dependence is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when the client makes which statement?

Accepted Answer

Coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.

Question 9

A client brought into the emergency department as a result of an automobile accident has a blood alcohol level (BAL) is 0.10 mg%. Based on this finding, the nurse would expect to assess which of the following?

Accepted Answer

A BAL of 0.10 mg% would be manifested by difficulty driving and coordinating movements. Ataxia and emotional lability would be associated with a BAL of 0.20 mg%. Stupor would be associated with a BAL of 0.30 mg%.

Question 10

A client with a history of opioid dependency is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess?

Accepted Answer

With moderate opioid withdrawal, pupils are dilated. Rhinorrhea, lacrimation, and dysphoria are noted with mild withdrawal.

Question 11

A nurse is implementing a brief intervention with a client diagnosed with alcohol dependency. The nurse most likely would be involved with which action?

Accepted Answer

Brief intervention involves a negotiated conversation between the nurse and the client that is designed to reduce the substance use. Asking the client questions about substance use refers to screening. Pointing out inconsistencies reflects confrontation. Helping the client change his or her way of thinking reflects a cognitive approach.

Question 12

A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?

Accepted Answer

Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body.

Question 13

The nurse is completing the admission of a client who is seeking treatment for alcoholism. The client tells the nurse, "The last time I had any alcohol to drink was at 10 a.m., before I left for the hospital." Which observation would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? Select all that apply.

Accepted Answer

A person in stage 1 of alcohol withdrawal syndrome exhibits slight diaphoresis, hand tremors, no confusion, elevated heart rate, and normal or slightly elevated blood pressure. Intermittent confusion suggests moderate alcohol withdrawal. A heart rate of 135 beats/min indicates stage 3 or severe alcohol withdrawal syndrome.

Question 14

A nurse is obtaining a history from a client who drinks about six cups of coffee and several diet cola drinks per day. The client states, "I just cut down my coffee and soda intake to one per day." Which symptoms would the nurse most likely expect to assess? Select all that apply.

Accepted Answer

The client's decreased intake of caffeine could lead to caffeine withdrawal, manifested by headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, and nausea. Flushing and diuresis would be characteristic of caffeine overdose.

Question 15

A group of nurses is reviewing information about substances that are abused. The nurses demonstrate understanding of the information when they identify which agent as a stimulant? Select all that apply.

Accepted Answer

Stimulants include cocaine and nicotine. Alcohol is a depressant. Heroin is an opioid derivative that depresses the central nervous system. Phencyclidine is classified as a hallucinogen.

Question 16

A client with a history of substance dependency is a member of a skills training group. Which training component would the client be involved in to enhance intrapersonal coping skills? Select all that apply.

Accepted Answer

Topics in skills training groups addressing intrapersonal issues include problem solving, awareness and management of anger, and planning for emergencies. Substance refusal skills and social support networking are skills addressing interpersonal issues.

Question 17

When using the CAGE assessment tool to determine a client's potential risk of alcoholism, the mental health nurse asks the client which question? Select all that apply.

Accepted Answer

The CAGE tool involves questions about respondents' beliefs of cutting down on their drinking, their experience of others criticizing their drinking, the presence of guilt about drinking, and early morning drinking. Questions such as "Have you ever thought you drink too much?"; "How do you feel when people tell you drink too much?"; "Do you feel sad or guilty when you drink?"; and "When was the last time you had a drink first thing in the morning?" would be appropriate. Trouble with the law is not addressed by the CAGE tool.

Quiz 31: Addiction and Substance Use-Related Disorders: Nursing Care of Persons With Alcohol and Drug Use Disorders