Substance-Related and Addictive Disorders Exam Questions and Answers.

Substance-Related and Addictive Disorders Exam Questions and Answers. A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be a priority outcome for this patient’s treatment plan while in the hospital? Patient will be medically stabilized while in the hospital. Patient will return to a predrug level of functioning within 1 week. Patient will take a leave of absence from college to alleviate stress. Patient will state within 3 days that he or she will totally abstain from drugs and alcohol. - ANSWER-Patient will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he or she will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal, such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. It is not likely that the patient will make a total commitment to abstinence within 1 week. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely. p. 423 .A nurse cares for a patient hospitalized 3 days ago with gastrointestinal bleeding. Today, the patient is irritable and restless and complains to the nurse, “There is too much noise in this hospital. The lights are so bright they are blinding me.” What is the nurse’s best action? Conduct a thorough search in the patient’s room for hidden alcohol. Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Assess for a delayed reaction to a blood transfusion given the first day of hospitalization. Notify the facility’s maintenance manager to adjust the lighting and intercom level in the patient’s room. - ANSWER-Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Gastrointestinal bleeding is a medical complication of chronic alcohol abuse; the admitting diagnosis is a clue to be observant for alcohol-related problems. Hypersensitivity to noises (which seem louder than usual) and light (which appears brighter than usual) is associated with severe alcohol withdrawal. Irritability and restlessness are additional clues to alcohol withdrawal. If the patient had been using alcohol from a hidden source, he or she would not be experiencing alcohol withdrawal. Reactions to blood transfusions occur immediately. After assessing the patient, the nurse may decide to adjust the room’s lighting and noise. p. 421 .A nurse interviews a 15-year-old who has engaged in frequent substance abuse. In addition to assessing substance abuse, the nurse should screen for which other problems in this adolescent? Depression Eating disorder Conduct disorder Antisocial personality Obsessive-compulsive disorder - ANSWER-Depression Eating disorder Conduct disorder Antisocial personality The high prevalence of psychiatric comorbidity is supported by statistics from multiple national population surveys. Individuals with mood and anxiety disorders, antisocial behaviors, or histories of conduct or oppositional disorders as adolescents are more than twice as likely to have a substance use disorder. Eating disorders may occur in people abusing stimulants or caffeine. Obsessive-compulsive disorder is not a comorbidity associated with substance abuse. pp. 412, 414, 427 .A nurse is assessing a patient, who has been withdrawing from cocaine. Which clinical findings of cocaine withdrawal does the nurse observe? Fatigue Depression Increased energy Poor concentration Decreased appetite - ANSWER-Fatigue Depression Poor concentration Cocaine is a stimulant, and its withdrawal may cause symptoms opposite to the stimulant effect. These include fatigue, depression, and poor concentration. Cocaine overdose may cause increased energy and decreased appetite as a result of its stimulant effect. p. 418 .A nurse is caring for a patient who has been abusing stimulants. Which symptoms does the nurse look for as a risk for suicide? Hallucinations Impulsiveness Social isolation Loss of occupation Elevated temperature - ANSWER-Impulsiveness Social isolation Loss of occupation Impulsiveness decreases the decision-making abilities and increases the patient’s risk for suicide. Social isolation and loss of occupation can make the patient feel depressed and lonely, which increases the patient’s risk for suicide. Hallucinations are altered perceptions, which may interfere with clear thinking and increase the patient’s risk for injuries. Elevated temperature increases the patient’s risk for injuries. p. 424, Table 22.5 .A nurse is learning how to manage patients with substance abuse disorders. Which step should the nurse apply as a first-line intervention in such cases? Sedating the patients Secluding the patients Providing safety and sleep Encouraging strenuous activities - ANSWER-Providing safety and sleep Because patients with substance use disorders are under variable influence of the drug effects, providing safety and sleep is essential to help the body recover. Strenuous activity should be avoided to prevent fatigue. Seclusion and sedation may not help the patient; these measures are used only when the patient is aggressive and harmful to self or others. p. 424 .A nurse is teaching high school students about commonly abused drugs and their effects. Which common substances are abused through swallowing? Opium Heroin Alcohol Nicotine Marijuana - ANSWER-Opium, Alcohol, Marijuana The substances that are abused by swallowing included opium, alcohol, and marijuana. Opium is an opioid that can be swallowed and smoked. Alcohol is found in liquor, beer, and wine and is abused through swallowing. Marijuana is a cannabinoid and can be swallowed and smoked. Nicotine is the main ingredient in tobacco and is smoked, snorted, or chewed. Heroin is an opioid and can be injected, snorted, and smoked. pp. 410-412, Table 22.1 .A patient describes experiences of having blackouts. The nurse suspects abuse of Alcohol Cocaine Mescaline Psilocybin - ANSWER-Alcohol Chronic abuse of alcohol is associated with blackouts (periods for which the patient has no memory). Abuse of cocaine produces feelings of euphoria. Abuse of mescaline and psilocybin causes alterations in perception. pp. 420-421 .A patient has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include Induction of vomiting Observation for cardiac dysfunction Administration of ammonium chloride Monitoring of opiate withdrawal symptoms - ANSWER-Observation for cardiac dysfunction Cardiac dysfunctions are observed in patients experiencing central nervous system stimulant overdose. p. 418, Box 22.2 .A patient hospitalized after a heroin overdose shares, “I’ve been using more heroin lately to get my usual high.” The nurse determines that this information supports the existence of what abuse-related outcome? Tolerance Addiction Intoxication Withdrawal - ANSWER-Tolerance Tolerance is described as needing increasingly greater amounts of a substance to become intoxicated or finding that using the same amount over time results in a much diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. p. 409