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25 Cards in this Set

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DSM-IV criteria for substance abuse
Impairment manifested by three or more of the following occuring within a 12 month period:
1. Recurrent use resulting in failure to fulfill major role obligations at work, school, or home
-Recurrent use in situations that are physically hazardous
-Recurrent substance-related legal problems
-Continued use despite persistent or recurrent problems caused or exacerbated by the effects of the substance.

Symptoms never met criteria for substance dependence
DSM-IV criteria for substance Dependence
Impairment manifested by three or more of the following
-Substance often taken in large amounts or over a longer period than was intended
-Persistent desire, unsuccessful efforts to cut down or control use
-Much time spent in activities to obtain the substance or use it
-Reduction of important social, occupational or recreational activities
-Use continued despite knowledge of having persistent or recurrent physical or psychological problems likely to have been caused or exacerbated by the substance.
Psychoactive Substances:
Drugs or chemicals that, when taken, alter one or several of the following-perception, awareness, consciousness, thinking, judgement, decision making, insight, mood, behavior.
Need for markedly increased amounts of the substance to reach intoxication or desired effect.

Tolerance that develops to a substance as a result of the use of a related substance.

Adverse physical and psychological symptoms that occur when a person ceases to use a substance.
Following a surgical procedure the patient states he does not want to take narcotic pain analgesics because he is afraid he will become addicted to the drug. Response by the nurse is based on the knowledge that: [Hint]
Dependence on narcotics is common among post-operative patients
Addiction to prescription drugs is rare when used according to protocol
Female patients are more likely to become addicted
Addiction is rare if the patient has a high pain threshold
Addiction to prescription drugs is rare when used according to protocol

Some patients and health professionals believe that therapeutic use of scheduled drugs create large numbers of addicted patients. Prescription drugs rarely cause addiction when used according to accepted medical protocols. The risk of addiction for prescription medications is primarily a function of the dose and the length of therapy.
The student nurse asks the registered nurse to explain the difference between physical and psychological dependence on a drug. Which of the following responses by the nurse is accurate? [Hint]
Psychological dependence results in development of withdrawal symptoms if the substance is discontinued
Physical dependence is the usual factor in a patient's relapse during addiction therapy
Physical dependence can occur quickly with repeated doses, especially with I.V. drugs
Psychological dependence does not interfere with the patients lifestyle
Physical dependence can occur quickly with repeated doses, especially with I.V. drugs

Physical dependence refers to an altered physical condition caused by the nervous system adapting to repeated substance use. Over time, the body's cells are tricked into believing that they are normal in the presence of the substance. Withdrawal symptoms occur when the substance is discontinued.
Which of the following patients is it most important to caution against attempting withdrawal from the drug without medical supervision? [Hint]

Symptoms of withdrawal me be particularly sever for patients physically dependent on alcohol and sedatives. Because of ht severity of the symptoms, the process of withdrawal from these agents is best accomplished in a substance abuse treatment facility.
The patient states he has been increasing the amount and frequency of the drug he is using. The patient has most likely developed ___________ to the drug. [Hint]
Tolerance is a biological condition that occurs when the body adapts to a substance after repeated administration. Over time, higher doses of the drug are required to produce the same initial effect.
Discharge teaching for a patient who is prescribed alprazolam (Xanax) for treatment of anxiety should include: [Hint]
Monitoring blood pressure
Monitoring respiratory rate
Taking the drug only at bedtime
Avoiding combining drug with alcohol
Avoiding combining drug with alcohol

Alprazolam(Xanax) is a benzodiazepine drug. Abuse of these drugs is uncommon, however they are frequently mixed with alcohol to augment their drug experience. Overdose from this combination can be fatal.
The patient addicted to heroin may be prescribed which of the following drugs to prevent withdrawal symptoms when heroin use is discontinued? [Hint]
Diazepam (Valium)
Fentanyl (Duragesic)
Methadone (Dolophine)
Triazolam (Halcion)
Methadone (Dolophine)

Methadone (Dolophine) is a narcotic sometimes used to treat opioid addition. Methadone has addictive properties of its own, however, it does not cause the same degree of euphoria as other opioids and its effects are longer lasting. Heroin addicts are switched to methadone in order to prevent withdrawal symptoms.
The patient presents to the emergency department with euphoria, paranoia and complaints of severe thirst, and hunger. He insists the nurse give his chocolate for his hunger. The nurse suspects substance abuse. Which substance has the patient most likely used? [Hint]
Use of marijuana slows motor activity, decreases coordination, and causes disconnected thoughts, feelings of paranoia, and euphoria. It increases thirst and craving for food, especially chocolate and other candies.
The nurse assesses a patient suspected of a drug overdose. The notes the patient has a runny nose, crusty redness around the nostrils, and deterioration of the nasal cartilage. The drug the patient most likely abused is: [Hint]

Cocaine is the second most commonly used illicit drug in the US. Routes of administration include snorting, smoking and injecting. Users who snort cocaine develop a chronic runny nose, a crusty redness around the nostrils, and deterioration of the nasal cartilage. Overdose can result in dysrhythmias, convulsions, stroke or death due to respiratory arrest.
The patient with a history of alcohol abuse is admitted to the hospital. The nursing care plan includes assessment of the patient for which of the following symptoms indicative of alcohol withdrawal? [Hint]
Mental depression, headaches, hunger
Insomnia, nausea, bradycardia
Tremors, hallucinations, delirium
Weakness, hypotension, violent yawning
Tremors, hallucinations, delirium

Patients experiencing alcohol withdrawal typically experience tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, and delirium.
The patient states he is going to quit smoking "cold turkey". The nurse teaches the patient to expect which of the following symptoms during withdrawal from nicotine? [Hint]
Headaches, increased appetite, insomnia
Depression, hallucinations, anorexia
Muscle spasms, hypertension, tremors
Excessive sweating, fatigue, seizures
Headaches, increased appetite, insomnia

Symptoms of nicotine withdrawal include irritability, anxiety, restlessness, headaches, increased appetite, insomnia, inability to concentrate, decrease in heart rate and blood pressure.
Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support?
A. Opiates
B. Marijuana
C. Barbiturates
D. Hallucinogens
C. Barbiturates

Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death.
Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of
A. tremors.
B. seizures.
C. blackouts.
D. hallucinations.
A. tremors.

Tremors are an early sign of alcohol withdrawal.
A client has been using cocaine intranasally for 4 years. Two months ago she started freebasing. For the past week she has locked herself in her apartment and has used $8000 worth of cocaine. When brought to the hospital she was unconscious. Nursing measures should include
A. induction of vomiting.
B. administration of ammonium chloride.
C. monitoring of opiate withdrawal symptoms.
D. observation for hyperpyrexia and seizures.
D. observation for hyperpyrexia and seizures

Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose.
An unconscious client is admitted to the emergency department. The admitting diagnosis is "rule out opiate overdose." Which item of assessment data would be most consistent with opiate overdose?
A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min
B. Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min
C. Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min
D. Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min
A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min;

Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.
5. Cocaine exerts which of the following effects on a client?
A. Stimulation after 15 to 20 minutes
B. Stimulation and anesthetic effects
C. Immediate imbalance of emotions
D. Paranoia
B. Stimulation and anesthetic effects
Cocaine exerts two main effects on the body, both anesthetic and stimulant.
. An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will
A. discuss the addiction with significant others.
B. state an intention to stop using illegal substances.
C. abstain from the use of mood-altering substances.
D. substitute a less-addicting drug for the present drug.
C. abstain from the use of mood-altering substances.
Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term.
7. A client was in an automobile accident. Although he has the odor of alcohol on his breath, his speech is clear and he is alert and answers questions posed to him. The law enforcement officer requests that the emergency department staff draw a blood sample for blood alcohol level determination. The level is determined to be 0.30 mg%. What conclusion can be drawn?
A. The client has a high tolerance to alcohol.
B. The client ate a high-fat meal before drinking.
C. The client has a decreased tolerance to alcohol.
D. No conclusions can be drawn from the data.
A. The client has a high tolerance to alcohol.

A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level.
8. A client brought to the emergency department at the university hospital after PCP ingestion tries to run up and down the hallway. The nursing intervention that would be most therapeutic is
A. taking him to the gym on the psychiatric unit.
B. obtaining an order for seclusion and close observation.
C. assigning a psychiatric technician to "talk him down."
D. administering naltrexone as needed per hospital protocol.
B. obtaining an order for seclusion and close observation.

Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist.
9. A teaching need is revealed when a client taking disulfiram states
A. "I usually treat heartburn with antacids."
B. "I take ibuprofen or acetaminophen for headache."
C. "Most over-the-counter cough syrups are OK for me to use."
D. "I have had to give up using aftershave lotion."
C. "Most over-the-counter cough syrups are OK for me to use."

The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol.
10. The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses
A. are an indicator of treatment failure.
B. are caused by physiological changes.
C. result from lack of good situational support.
D. can be learning situations to prolong sobriety.
C. result from lack of good situational support

Relapses can point out problems to be resolved and can result in renewed efforts for change.
Relapses can point out problems to be resolved and can result in renewed efforts for change.