Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E

Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E

Chapter 07: Drugs of Abuse

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

MULTIPLE CHOICE

1. The nurse is teaching a group in the community about drug abuse. Which statement by the nurse is correct?

a.

“Cue-induced cravings eventually disappear after long periods of abstinence by the person addicted to drugs.”

b.

“Substance abuse and addiction are synonymous terms, describing dependence on drugs.”

c.

“Substance use disorder occurs when recurrent use causes clinically and functionally significant impairment.”

d.

“Substance use disorder occurs when physical dependence is present.”

ANS: C

Drug addiction occurs when emotional and mental dependence on a drug is present. Although physical dependence may often occur, it is not always present. Cue-induced cravings may diminish after long abstinence but do not disappear completely. Drug abuse may occur without addiction.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 60

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Psychosocial Integrity: Dependency

2. The nurse is caring for a patient who is being treated for chronic alcohol intoxication. The nurse notes that the patient’s serum alcohol level is 0.40 mg%. The patient is awake and talkative even though this is a potentially lethal dose. The nurse recognizes this as alcohol

a.

substance use disorder.

b.

dependence.

c.

misuse.

d.

tolerance.

ANS: D

Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-naïve person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Addiction describes continued involvement in an activity despite the substantial harm it causes. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Misuse refers to using a drug or substance to excess.

DIF: Cognitive Level: Applying (Application) REF: p. 60

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity: Dependency

3. What does the nurse understand must occur in order to produce withdrawal syndrome?

a.

Intoxication

b.

Craving

c.

Drug tolerance

d.

Physical dependence

ANS: D

Patients who develop a physical dependence on a drug will experience withdrawal syndrome when the drug is stopped. Intoxication is a condition that results in disturbances in the level of consciousness, cognition, perception, judgment, behavior, and other psycho-physiologic functions. Cravings can occur without physical dependence. Tolerance refers to a decrease in drug effects with repeated use.

DIF: Cognitive Level: Applying (Application) REF: p. 60

TOP: Nursing Process: N/A

MSC: NCLEX: Psychosocial Integrity: Dependency

4. The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct?

a.

“Bupropion (Zyban) is effective and does not have serious adverse effects.”

b.

“Nicotine replacement therapies are effective and eliminate the need for behavioral therapy.”

c.

“Varenicline (Chantix) may be used short-term for 1 to 2 months.”

d.

“You may experience headaches, irritability, and increased appetite for several months after stopping smoking.

ANS: D

Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but has many serious effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 4 months.

DIF: Cognitive Level: Applying (Application) REF: p. 71

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Psychosocial Integrity: Dependency

5. A patient with asthma has been using a nicotine transdermal 24-hour patch for 3 weeks to quit smoking. The patient reports having difficulty sleeping. What action will the nurse take?

a.

Ask the provider for a prescription for Nicotrol NS.

b.

Recommend removing the patch at bedtime.

c.

Suggest using an 18-hour patch instead.

d.

Tell the patient to stop the patch and join a support group.

ANS: C

The patient should try an 18-hour patch to help with sleep. Nicotrol is not a good option for patients with asthma.

DIF: Cognitive Level: Applying (Application) REF: p. 70

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Psychosocial Integrity: Dependency

6. The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking?

a.

“I don’t smoke around my children or inside the house.”

b.

“I want to stop smoking, but I will need help to do it.”

c.

“I will quit so my coworkers will stop harassing me about it.”

d.

“If I cut down gradually, I should be able to quit.”

ANS: B

Patients exhibit readiness when they state a desire to quit along with a request for professional assistance. Other factors, such as children or coworkers, do not indicate a desire to quit.

DIF: Cognitive Level: Applying (Application) REF: p. 70

TOP: Nursing Process: Nursing Intervention/Planning

MSC: NCLEX: Psychosocial Integrity: Dependency

7. A patient is using Commit lozenge 2 mg to help quit smoking and reports nausea and indigestion. The nurse will instruct the patient to perform which action?

a.

Allow the lozenge to dissolve slowly over 20 to 30 minutes.

b.

Chew the lozenge thoroughly before swallowing it.

c.

Increase to 4 mg and use less often.

d.

Take the lozenge with food and a full glass of water.

ANS: A

The patient should allow the lozenge to dissolve slowly. Chewing or swallowing the lozenge increases gastrointestinal side effects. Increasing the dose and decreasing the frequency is not recommended.

DIF: Cognitive Level: Applying (Application) REF: p. 70

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Psychosocial Integrity: Dependency

8. A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug?

a.

Alcohol

b.

Cocaine

c.

Lysergic acid diethylamide (LSD)

d.

Oxycodone

ANS: B

A stimulant psychosis can occur with chronic use of any stimulant and, with cocaine, progresses to visual hallucinations of colored lights and tactile hallucinations of bugs crawling under the skin. These are not signs of abuse with alcohol or oxycodone. LSD is classified as a hallucinogen.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 63

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity: Dependency

9. The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug?

a.

Alcohol

b.

Cocaine

c.

LSD

d.

Methamphetamine

ANS: D

Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay and dermatologic deterioration.

DIF: Cognitive Level: Understanding (Comprehension) REF: p. 64

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity: Dependency

10. The nurse is teaching a patient who has completed detoxification for alcohol abuse who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching?

a.

“Even topical products containing alcohol can have serious adverse effects while I am taking this drug.”

b.

“If I experience drowsiness or skin rash, I should discontinue this drug immediately.”

c.

“It is safe to take a product containing alcohol one week after the last dose of disulfiram.”

d.

“This drug acts by blocking the pleasurable effects of alcohol.”

ANS: A

Disulfiram causes an unpleasant and potentially fatal reaction if alcohol is consumed while taking the drug and can even occur with topical products containing alcohol. Drowsiness and skin rash are not common adverse effects. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol.

DIF: Cognitive Level: Applying (Application) REF: p. 61

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Psychosocial Integrity: Dependency

11. A patient who has a long history of alcohol abuse is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate giving intravenous

a.

dopamine to restore blood pressure.

b.

fluid boluses to treat dehydration.

c.

glucose to prevent hypoglycemia.

d.

thiamine to treat nutritional deficiency.

ANS: D

Thiamine should be given to prevent Wernicke encephalopathy in patients treated for alcoholism. If glucose is indicated, the thiamine should be given first. Other treatments are given as indicated.

DIF: Cognitive Level: Applying (Application) REF: p. 67

TOP: Nursing Process: Nursing Intervention/Planning

MSC: NCLEX: Psychosocial Integrity: Dependency

12. A patient arrives in the emergency department in an acute state of alcohol intoxication and reports chronic consumption of “several six packs” of beer every day for the past year. The nurse anticipates administering which medication or treatment?

a.

Chlordiazepoxide (Librium)

b.

Disulfiram (Antabuse)

c.

Gastric lavage

d.

Vasoconstrictors

ANS: A

To prevent acute withdrawal and delirium tremens, a long-acting benzodiazepine, such as chlordiazepoxide, is given. Disulfiram would cause an acute drug interaction. Gastric lavage should no longer be performed, and vasoconstrictors are not indicated.

DIF: Cognitive Level: Applying (Application) REF: p. 72

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Psychosocial Integrity: Dependency

13. A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of drug abuse in the patient’s home. The nurse suspects that this patient has had an overdose of which substance?

a.

Alcohol

b.

LSD

c.

An opioid

d.

Methamphetamine

ANS: C

Opioid overdose is characterized by constricted pupils and respiratory depression.

DIF: Cognitive Level: Applying (Application) REF: p. 69

TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity: Dependency

14. A patient is brought to the emergency department after ingesting an overdose of an opioid several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action?

a.

Administer activated charcoal.

b.

Give flumazenil (Romazicon).

c.

Give naloxone (Narcan).

d.

Perform gastric lavage.

ANS: C

Naloxone is the drug of choice in the treatment of respiratory depression associated with opioid overdose. Flumazenil is the antidote for benzodiazepine overdose. Activated charcoal is used for asymptomatic patients who have recently consumed the drug. Gastric lavage should no longer be performed for treatment.

DIF: Cognitive Level: Applying (Application) REF: p. 69

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Psychosocial Integrity: Dependency

15. A patient with a history of opioid abuse will be discharged home with buprenorphine to help prevent relapse. Which product will the nurse anticipate the provider to order?

a.

Buprenex

b.

Suboxone

c.

Subutex

d.

Vivitrol

ANS: A

Buprenex is an agonist–antagonist opioid that can be used for detoxification and maintenance therapy because it has a low potential for abuse. Suboxone and Subutex have abuse potential. Vivitrol does not contain buprenorphine and does not prevent cravings.

DIF: Cognitive Level: Applying (Application) REF: p. 69

TOP: Nursing Process: Nursing Intervention/Planning

MSC: NCLEX: Psychosocial Integrity: Dependency

16. The nurse is teaching a patient who will be discharged home with naltrexone (ReVia) after treatment for opioid addiction. What information will the nurse include in the teaching for this patient?

a.

“This drug will help control cravings.”

b.

“You may take this drug once weekly.”

c.

“ReVia blocks the pleasurable effects of opioids.”

d.

“If you discontinue this drug abruptly, you will have withdrawal symptoms.”

ANS: C

ReVia acts by blocking the pleasurable effects of opioids. It can precipitate withdrawal when given to opioid-dependent patients. This drug does not control cravings, and it is taken once daily or every other day.

DIF: Cognitive Level: Applying (Application) REF: p. 69

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Psychosocial Integrity: Dependency