Alcohol, Tobacco, and Other Drug Problems in the Community Stanhope: Foundations of Population Health for Community/Public Health Nursing, 5th Edition,100% CORRECT

Alcohol, Tobacco, and Other Drug Problems in the Community Stanhope: Foundations of Population Health for Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education ANS: B The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research. 2. A woman has just delivered a baby and is lamenting that the baby’s father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, “It’s so sad. He’s clearly no good.” Which of the following would be the best response by the nurse? a. “I’m so sorry to hear that. Is your mother able to be with you?” b. “It’s good that you and thNe baRby Iare GsafeBCm hMim.” c. “Is there anyone to help you with the baby until the baby’s father can be released and encouraged to get treatment for his addiction?” d. “You must hate him for leaving you alone with a new baby!” ANS: C The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying “you must hate him” is not appropriate, as it is not the nurse’s role to tell the client how she should be feeling. 3. A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse ANS: C Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful. 4. A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth. ANS: B Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person’s risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances. 5. A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to “win” the drinking contest when the other passes out and cannot continue? NURSINGTB.COM a. If their drinks are the same size, they’ll both pass out about the same time. b. If they play fair, they’ll probably both vomit before passing out. c. The man will win. d. The woman will win. ANS: C Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men (except for males with chronic alcoholism). It is unlikely that the woman will win, as women are more affected by alcohol than men. It is also unlikely that they will both “win” at the same time because the alcohol will likely affect the woman facter than the man. 6. Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to “just say no” when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d. The fact that tobacco smoking causes more deaths than any other behavior in the United States ANS: D The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior the other topics of commonly used drugs on campus, just “saying no”, and overcoming peer pressure may have been just as appropriate. 7. A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother’s arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home. ANS: B Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than does mainstream smoke. 8. Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) NURSINGTB.COM d. Mixed alcoholic beverages ANS: B Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used. 9. A school nurse stops a student in the hall and asks whether the student has been having trouble with her eyes, which look rather red and dry. The female student yawns and says that she hasn’t noticed any eye problems. However, she does confess to the school nurse that she has gained 15 pounds since she began smoking “special cigarettes.” Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana ANS: D Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tabacco use is associated with many chronic diseases and a person smoking tobacco would not display these symptoms. 10. Which of the following is an accurate concern about the use of marijuana? a. Marijuana has painful withdrawal symptoms. b. Marijuana may damage the respiratory tract. c. Marijuana can often reduce pain but physicians refuse to prescribe it. d. Marijuana quickly leads to psychological and physiological dependence. ANS: B Marijuana is the most widely used illicit drug in the United States. It is not highly toxic except for possible damage to the respiratory tract from smoking. It may reduce pain but is currently illegal with national efforts at total prohibition. It does not quickly lead to dependence, and withdrawal symptoms are mild. 11. A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, temperature. Which of the following would most likely cause these symptoms? a. Alcohol b. Bath salts c. Heroin d. Marijuana ANS: B Bath salts are crystalline powder that can be swallowed, inhaled or injected and that is highly addictive. They contain man-made stimulations, cathinones, which are similar to amphetamines. They increase dopamine levels and create feelings of euphoria. Ecstasy raises the body’s temperature, pulse rate, and blood pressure. Alcohol, heroin, and marijuana would all have a depressant effect. NURSINGTB.COM 12. A home health nurse believes a client may be a drug addict. However, the client denies the use of drugs when questioned by the nurse. Which of the following is the most likely cause of the client’s denial? a. Confusion resulting from dementia b. History of compulsive lying c. Mental status changes d. Use of addictive drugs ANS: D Denial is a primary symptom of drug addiction. A problem should be suspected if the client becomes defensive or exhibits other behavior indicating denial when asked about alcohol or other drugs. Confusion, a history of lying, and mental status changes would most likely not be the cause of the client’s denial. 13. Three women were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STD tests ANS: A Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STD test would not be the priority. 14. A male IV drug abuser admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases ANS: D Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem. 15. A man is addicted to alcoholN. In RwhiIch oGf thBe .foCllowMing scenarios is a family member enabling the man to continue drinking? a. The wife asks the nurse to explain why her husband’s continued drinking is dangerous. b. The son threatens to leave home because he finds the father’s behavior embarrassing. c. The teenage daughter turns to a favorite teacher for emotional support. d. The wife tells her husband’s boss that her husband is sick when he is actually inebriated. ANS: D Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When the wife lies for the husband, she is enabling the behavior to continue. The other options do not demonstrate the behavior of enabling, shielding the man from experiencing the consequences of the addiction. 16. Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment. ANS: B Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting and effective when taken orally, it does not produce a “high,” it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs. 17. A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement products ANS: A The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker’s environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. Acupncture, behavior modification, and nicotine replacement products may all assist the client in stopping smoking. However, it has been demonstrated that the most effective method involves a combination of strategies. 18. A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, “I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal.” Which of the following would be most appNropRriateIresGponBse.fCromMthe nurse? a. “I’m so glad you’re beginning to recognize the need to control your blood sugar.” b. “Now you just have to make sure you don’t give that habit up!” c. “Sounds like you’re not ready to really plan your eating yet.” d. “That is great. You’ve started to take action and make changes.” ANS: D There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. As the client learns how to eat and recognizes what she is eating, she is preparing for action. Therefore, the nurse should be encouraging and recognize that the client has begun serious change. This comment by the client demonsrates that the client is ready to take action and needs to be encouraged by the nurse. The incorrect responses are not encouraging replies that would promote the client to continue to move forward with these actions. 19. At a county board meeting, a nurse reports statistics related to the increasing problem of substance abuse in the county. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being “on the streets.” c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity. ANS: D The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. The purpose of the nurse requesting this funding is to address the problem of substance abuse, not obesity. This program may offer an alternative to children and keep them safe and off of the streets; however, the primary objective is to address the overall healthy lifestyle of these youth. 20. A school health nurse is conducting drug screening to detect drug use by students before problems develop. Which of the following levels of prevention does this action represent? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary and secondary prevention ANS: B One means of secondary prevention is to institute early detection (screening) programs in schools, the workplace, and other areas in which people gather to determine the presence of substance abuse. Primary prevention involves education before a problem occurs. Tertiary prevention occurs after the problem has occurred and aims to assist the client to the highest level of functioning. MULTIPLE RESPONSE 1. A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the followNing RstraItegiGes wBCd thMe nurse suggest the mother implement? (Select all that apply.) U S N T O a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships. ANS: A, B, C Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. Based on the inforamtion provided, there is no reason to suggest the the child needs to develop new friendships. Keeping consistent friendships may provide the support the child needs to avoid engaging in these behaviors. 2. A nurse is helping a client’s family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client’s family members would be most effective? (Select all that apply.) a. “Express your love and your belief that he can change.” b. “Point out that his behavior is his choice and his responsibility.” c. “Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important.” d. “Remind him that entering treatment is better than going to prison.” ANS: A, B Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person’s own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of Self-efficacy. Having the client’s family members tell the father that they understand his behavior does not encourage him to realize the need for change. Threatening a future possibility of prison would not provide encouragement to the father and may even challenge him to continue his behavior. 3. A nurse is developing a community-based activity aimed at preventing substance abuse in the community. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Support an increase in the availability of recreational facilities. b. Lobby to state legislators to approve a higher cigarette tax. c. Educate preschoolers about the long-term side effects of drugs and alcohol. d. Provide general screenings for substance abuse. ANS: A, D Supporting an increase in additional recreational facilities would engage the community members in healthy activities rather than having them potentially turn to substances for relaxation. Providing screenings for substance abuse in the community may assist community members in recognizing the problem sooner. It would not be appropriate to educate preschoolers about the long-tNerUmRsSidIe NefGfeTctBs .ofCdOruMgs and alcohol. Preschoolers have difficulty understanding long term effects. This education may be more appropriate for older students. Lobbying state legislators for increase in a higher cigarette tax may be beneficial, but this intervention is focused on a larger area than only the community where the nurse is working. 4. A home health client has been taking acetaminophen with codeine, a narcotic analgesic, every 4 hours for pain following a hip arthroplasty. Which of the following statements made by a nurse to the client’s physician indicates a need for further education on narcotics? (Select all that apply.) a. “You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief.” b. “You need to discontinue that order before my client becomes addicted.” c. “You need to prescribe a different medication so that my client will achieve adequate pain relief.” d. “You need to give my client something in addition to this medication.” ANS: A, C, D It would not be appropriate to ask to decrease the time interval in between doses as the increased use of acetaminophen may be damaging to the client’s liver and kidneys. There is no evidence that this client is at risk for developing an addiction. Thus, demanding that this medication be discontinued may be a premature action by the nurse. However, the nurse should monitor the patient closely for signs and symptoms of potential addiction. Rather than adding another medication, the physician may want to consider changing the medication. It would be appropriate to ask the physician for a different medication to possibly assist with the client achieving optimal pain relief. It was once thought that opiods were by far the most effective drugs for pain relief; however, this belief is now being questioned. NURSINGTB.COM