Substance Abuse Nclex 1j6u1p

http://wps.prenhall.com/chet_lemone_medicalsurg_4/61/15844/4056113.cw/index.html Chapter 6- Nursing Care of clients with problems of substance abuse - LeMone- Burke 1- The school nurse is teaching a group of high school students about substance abuse. Which of the following people are most likely to develop a substance abuse problem? 1. 2. 3. 4.

An Asian woman A Jewish man A Roman Catholic man A Jewish woman

Answer: 3 Rationale: Various risk factors help explain why one person becomes addicted while another does not. Genetic, biological, psychological, and sociocultural factors shed light on how a person may abuse or become dependent on a substance. # 1 is incorrect because Asian Americans report the lowest prevalence of family history of alcoholism. Also, women drink less alcohol and have fewer alcohol-related problems than men. # 2 is incorrect because people of Jewish faith have the lowest rate of alcoholism. # 3 is correct because Roman Catholics have the highest rate of alcoholism. # 4 is incorrect because the person is Jewish and a woman which puts her in a lower risk bracket.

2-The nurse is working night shift with another nurse who has been exhibiting some problematic behaviors, such as weight loss, tachypnea, tachycardia, insomnia, memory loss, and paranoia. Abuse of which of the following substances could contribute to this behavior? 1. 2. 3. 4.

Caffeine Amphetamines Nicotine Alcohol

Answer:2 Rationale: Amphetamines cause arousal and an elevation of mood with a sense of increased strength, mental capacity, selfconfidence, and a decreased need for food and sleep. Methamphetamine s in treatment have reported physical symptoms associated with the use of methamphetamine including weight loss, tachycardia, tachypnea, hyperthermia, insomnia, and muscular tremors. The behavioral and psychiatric symptoms reported most often include violent behavior, repetitive activity, memory loss, paranoia, delusions of reference, auditory hallucinations, and confusion or fright. 3- A nurse is assessing a group of teens for characteristics of abuse. Which of the following characteristics may be indicative of abuse? Select all that apply. 1. 2. 3. 4. 5. 6.

Loss of control over consumption High tolerance for frustration and pain Impaired social and occupational functioning Development of tolerance and dependence Rebellion against social norms Anxiety, anger, and low self-esteem

Answer: 1, 3, 4, 5, 6 Rationale: No addictive personality type exists. However, many abs have several characteristics in common. #’s 1, 3, 4, 5, and 6 all are characteristics

4- A nurse is examining a client who has stopped smoking abruptly without the use of any assistive aids in the process. Which statement made by the nurse would demonstrate an understanding of nicotine abuse? 1. “Initially, nicotine decreases respiration, mental alertness, and cognitive ability.” 2. “Tolerance of nicotine can develop to nausea and dizziness, but not to the cardiovascular effects.” 3. “Some withdrawal symptoms of nicotine include decreased appetite, weight loss, impatience, and increased hostility.” 4. “Nicotine acts on the central nervous system as a depressant.”

Answer: 2 Rationale: # 1 is incorrect because nicotine initially increases respiration, mental alertness, and cognitive ability, but eventually depresses these responses. # 3 is incorrect because the appetite would be increased and there would be weight gain. . # 4 is incorrect because nicotine acts on the central nervous system as a stimulant, and not as a depressant.

5The nurse is counseling a young pregnant client about the potential effects of marijuana on her unborn baby. This pregnant woman has a social history of occasional marijuana use. Which of the following effects could marijuana have on the baby? 1. 2. 3. 4.

High birth weight Larger head circumference Normal length Fetal death

Answer: 4 Rationale: Birth defects may be associated with marijuana use. Marijuana crosses the placental barrier and is spread to the fetal tissues. When a pregnant woman smokes marijuana she increases the risk of abnormalities in the fetus such as CNS disturbances, low birth weight, decreased length, smaller head circumference, and fetal death. # 1 is incorrect because it should be low, not high birth weight. # 2 is incorrect because the head circumference would be smaller. # 3 is incorrect because the length would be decreased. 6The student health nurse at a large university is assessing the client who was just brought in by friends after a night of partying. The friends report no drug use by the client but report unusual behavior for the last couple of hours. Which of the following hallucinogens could be given to the client without knowledge? 1. 2. 3. 4.

Ecstasy P Ketamine Marijuana

Answer: 1 Rationale: MDMA, commonly known as Ecstasy, had high use in the 1980’s as a popular recreational “club drug” associated with dance clubs or “raves”. It has reappeared in recent years as a date or rape drug. Parties where there are other drugs or alcohol present may lead to easier access or availability of Ecstasy. This client may have been given Ecstasy without any knowledge or consent. The client would have to agree to take all of the other drugs.

7-The nurse its a client in alcohol withdrawal to the unit. Which type of care will be most important for this client to receive? 1. 2. 3. 4.

Medical Care Nursing Care Psychiatric Care Interdisciplinary Care

Answer: 4 Rationale: Effective treatment of substance abuse and dependence results from the efforts of an interdisciplinary team specializing in the treatment of psychiatric and substance abuse disorders.

8- A client is brought into the emergency room after a family friend found the client barely breathing with a half filled bottle of morphine next to the sofa. Which of the following symptoms would be indicative of an overdose? 1. 2. 3. 4.

Myocardial Infarction (MI) Stroke Pupil Dilation Ataxia

Answer: 3 Rationale: Signs of a stimulant overdose, such as in crack cocaine usage include MI, stroke, and ataxia. This is why answers 1, 2, and 4 are all incorrect. Morphine is an opiate that has the following signs of overdose: pupil dilation due to anoxia respiratory depression-arrest, coma, shock, convulsions, and death.

9-The school nurse is coordinating a program for middle school students on substance abuse. The nurse is encouraging the students to employ healthy lifestyles, stress management, and good nutrition. The nurse also covers information on ways to avoid peer pressure. Under which part of the nursing process does this education apply? 1. 2. 3. 4.

Assessment Diagnosis Health Promotion Implementation

Answer: 3 Rationale: Health promotion efforts are aimed at preventing drug use among children and adolescents and reducing risks among adults. Adolescence is the most common phase for the first experience with drugs. Healthy lifestyles, parental , stress management, good nutrition, and information about ways to steer clear of peer pressure are important topics for the nurse to provide in school programs.

10-The wealthy family of a client with substance abuse is visiting the client at the inpatient psychiatric facility. The family of the client is pleasant but disengages each time the topic of the treatment plan is broached. Which of the following nursing diagnoses would be most appropriate for the client and the family? 1. 2. 3. 4.

Denial, Ineffective Deficient Knowledge Thought Processes, Disturbed Coping, Ineffective

Answer: 1

Rationale: In this case, there is not a disturbed thought process or knowledge deficit. Rather, it is the denial on the part of the family that is causing a problem in dealing with the substance abuse. Ineffective denial is a better answer than ineffective coping because the realization that a problem exists is still absent. Coping can commence once the problem is acknowledged.

Hohman, M.M., Shillington, A.M., & Baxter, H.G. (2003). A comparison of pregnant women presenting for alcohol and other drug treatment by S status. Child Abuse and Neglect, 27(3), 303-317. Chang, J. C., Dado, D., Frankel, R. M., Rodriguez, K. L., Zickmund, S., Ling, B. S., et al. (2008). When pregnant patients disclose substance use: Missed opportunities for behavioral change counseling. Patient Education & Counseling, 72(3), 394-401. Haight, W. L., Carter-Black, J. D., & Sheridan, K. (2009). Mothers' experience of methamphetamine addiction: A case-based analysis of rural, Midwestern women. Children & Youth Services Review, 31(1), 71-77. Havens, J. R., Simmons, L. A., Shannon, L. M., & Hansen, W. F. (2009). Factors associated with substance use during pregnancy: Results from a national sample. Drug & Alcohol Dependence, 99(1-3), 89-95. Jones, H. E., Martin, P. R., Heil, S. H., Kaltenbach, K., Selby, P., Coyle, M. G., et al. (2008). Treatment of opioid-dependent pregnant women: Clinical and research issues. Journal of Substance Abuse Treatment, 35(3), 245-259. Winklbaur, B., Kopf, N., Ebner, N., Jung, E., Thau, K., & Fischer, G. (2008). Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. Addiction, 103(9), 14291440.

Bauer, C.R., Langer, J.C., Shankaran, S., Bada, H.S., Lester, B., Wright, L.L., et al. (2005). Acute neonatal effects of cocaine exposure during pregnancy. Archives of Pediatrics & Adolescent Medicine, 159(9), 824-834.