Arnad, Ed – Robert D.C.Diansuy, Michaella Tisha Marie

Dimalaluan, Dave NelsonTutor, Juvy

BSN IV-E; NCA 401-E

SUBSTANCE ABUSE NOTES AND QUESTIONS

REVIEW NOTES:

A-LCOHOL ABUSE ----------------------happy – socializing Narcotic oversode-give Narcan -escape from problem Narcotic detox- Methadone

-peer pressure Aversion therapy-Antabuse

B-blackout ---------------- awake but unawareC-confabulation ---------- invent stories to increase Self-EsteemD-denial -------------------“ I am at not an alcoholic.”D-dependence ------------“ I cant live without alcohol.”a. physical – tremors, tachycardia, restlessb. psychological – cravingE-enabling/codependency (significant others tolerate abusers)

DISULFIRAM voids alcohol beer version therapy ntabuse (DISULFIRAM) lcoholics anonymous n/v

hypotensioninterval of alcohol & antabuse:

12h interval after alcohol intake

B1 – Thiamine

Complications wernickesEncephalopathyKorsakoff psychosis

Wernickes – VROOM – Motor sx effectKorsakoff – memory- confabulation

24 – 72h after alcohol intakeDelirium tremors – happens due SNS activation

Tremors, hallucinations, illusions. Well lit room – to avoid hallucinations

ANTI DEPRESSANTS – decrease serotonin problem Anti depressants – full stomachAll meds take on a full stomach, except anti anxiety.

ASENDIN TCANORPRAMIN TCATOFRANIL TCASINEQUAN TCAANAPRANIL TCA - OCAVENTYL TCA

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VIVACTIL TCAELAVIL TCAPROZAC SSRIPAXIL SSRIZOLOFF SSRILUVOX SSRI

Serotonin ---------makes us happy

Decrease serotonin – pt becomes sad – depressionIncrease serotonin – antidepressant

SSRI:

Selective S Serotonin S – (decrease S/E)Reuptake R – Inhibitors I – (1 – 4 weeks)

If SSRI don’t work, give TCA

Tri Cyclic Antidepressants –( TCA) ----------2 – 4 wks has increased S/E increased Serotonin & Norephinephrine

MAOI-------------------------- effect 2 – 6wksIncrease E, NE, serotonin kills serotonin - MAOI

increase MAO = decrease serotonin* decrease MAO = increase serotonin

give MAOIMost dangerous, most S/EDiet – avoid tyramine food – eat SARIWA, fresh foodsHPN crisis – dangerous! Increase CR, diaphoresis

Tyramine rich food:Avocado PicklesAlcohol Fermented foodsBeer EggplantChocolate preservatives – tocino, bologna,canned meat etc. Cheese – mozerella, swiss cheeseW – ineS – soysauce

Anticholinergic = antidepressants – antiparasympatheticDry, constipation, retention, tachycardiaMale erectile dysfunction

MAOImARplan

NARdil PARnate

SUBSTANCE ABUSEType of Addict:

1. Nervous -----tremors Give downers

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Sx of overdose1. Identify if drug is upper or downer2. Check effect3. Sx of withdrawalIf patient takes a downer, all vital signs are down! If he stops taking it (during withdrawal), patient will experience the opposite effect of a downer. All his vital signs will shoot up! Same with uppers. Ex: Pt had cocaine intoxication. Pt will manifest hyperactivity, tachypnea, seizure. During withdrawal, pt will manifest bradypnea or coma.

Substance Abuse Moments(downer)A – alcoholB – barbituratesO – opiates AntidoteN – narcotics - Narcan (narcotic antagonist)M – marijuana

MorphCODEHERO

(uppers)

C – cocaineH – HallucinogensA – amphetamines

Uppers DownersSeizure decrease RR, decrease HRTachypnea Para constricted pupil

Moist mouthDilated Blood Vessels

ComaAsleepDecreased GI constrictionDecrease GU retentionDecrease BP

State of euphoria

Sx of withdrawal – reverse of effect1. Know if upper or downer2. Opposite of effect

Overdose Withdrawal (opposite of withdrawal is overdose)Alcohol – coma seizureMorphine – bradypnea tachypnea

Detox – withdrawal with MD supervision Methadone

2. Depressed - Sits down on chair

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UppersCodeine increased heart increase - BP increase, awakeHallucinogen sympathetic HR increase seizureAmphetamine pupils- dilate GI - diarrhea

Mouth – dryDecrease appetite - thin

Stop uppersTremors crash syndrome Depressed SuicideFatigue

Substance Abuse Psychiatric Nursing Questions:

1. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?

A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"B. "It's your decision. If you don't want to go, you don't have to."C. "You seem upset about the meetings."D. "You have to go to the meetings. It's part of your treatment plan."7. During which phase of alcoholism is loss of control and physiologic dependence evident?

A. Prealcoholic phaseB. Early alcoholic phaseC. Crucial phaseD. Chronic phase 

2. Which of the following is important when restraining a violent client?

A. Have three staff members present, one for each side of the body and one for the head.B. Always tie restraints to side rails.C. Have an organized, efficient team approach after the decision is made to restrain the client.D. Secure restraints to the gurney with knots to prevent escape.

3. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?

A. Dilated pupilsB. NystagmusC. ParanoiaD. Altered mood

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4. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?

A. WithdrawalB. Logical thinkingC. RepressionD. Denial

5. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:

A. avoid all products containing alcohol.B. adhere to concomitant vitamin B therapy.C. return for monthly blood drug level monitoring.D. limit alcohol consumption to a moderate level.

6. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:

A. barbiturates.B. amphetamines.C. methadone.D. benzodiazepines.

7. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:

A. dilated pupils and slurred speech.B. rapid speech and agitation.C. dilated pupils and agitation.D. euphoria and constricted pupils.

8. Which of the following signs should the nurse expect in a client with known amphetamine overdose?

A. HypotensionB. TachycardiaC. Hot, dry skinD. Constricted pupils

9. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available.

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After the nurse completes the initial assessment, what is the first priority?

A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and outputB. Checking the client's medical records for health history informationC. Attempting to contact the client's family to obtain more information about the clientD. Restricting fluids and leaving the client alone to "sleep off" the episode10. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?

A. Abstinence is the basis for successful treatment.B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.C. For treatment to be successful, family members must participate.D. An occasional social drink is acceptable behavior for the alcoholic

11. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:

A. lidocaine (Xylocaine).B. procainamide (Pronestyl).C. nitroglycerin (Nitro-Bid IV).D. epinephrine.

12. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?

A. "Why didn't you get someone else to drive you?"B. "Tell me how you feel about the accident."C. "You should know better than to drink and drive."D. "I recommend that you attend an Alcoholics Anonymous meeting." a

13. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?

A. Vomiting, diarrhea, and bradycardiaB. Dehydration, temperature above 101° F (38.3° C), and pruritusC. Hypertension, diaphoresis, and seizuresD. Diaphoresis, tremors, and nervousness

14. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:

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A. norepinephrine (Levophed) and lidocaine (Xylocaine).B. nifedipine (Procardia) and lidocaine.C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).D. nifedipine and esmolol

15. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?

A. The client will commit to a drug-free lifestyle.B. The client will work with the nurse to remain safe.C. The client will drink plenty of fluids daily.D. The client will make a personal inventory of strengths

15. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?

A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."B. "I only spend half of my paycheck at the bar."C. "I just drink to relax after work."D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

16. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?

A. Coronary artery spasmB. BradyarrhythmiasC. Neurobehavioral deficitsD. Panic disorder

17. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

A. begin after 7 days.B. not occur at all because the time period for their occurrence has passed.C. begin anytime within the next 1 to 2 days.D. begin within 2 to 7 days.

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18. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?

A. Keeping the client restrained in bedB. Checking the client's blood pressure every 15 minutes and offering juicesC. Providing a quiet environment and administering medication as needed and prescribedD. Restraining the client and measuring blood pressure every 30 minutes

19. Which assessment finding is most consistent with early alcohol withdrawal?

A. Heart rate of 120 to 140 beats/minuteB. Heart rate of 50 to 60 beats/minuteC. Blood pressure of 100/70 mm HgD. Blood pressure of 140/80 mm Hg

20. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?

A. The student discusses conflicts over drug use.B. The student accepts a referral to a substance abuse counselor.C. The student agrees to inform his parents of the problem.D. The student reports increased comfort with making choices.

21. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?

A. clozapine (Clozaril)B. thiothixene (Navane)C. lorazepam (Ativan)D. lithium carbonate (Eskalith)

22. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?

A. Al-AnonB. Make Today CountC. Emotions AnonymousD. Alcoholics Anonymous

23. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:

A. psychotherapy.B. total abstinence.

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C. Alcoholics Anonymous (AA).D. aversion therapy.

24. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?

A. SeizuresB. ShiveringC. AnxietyD. Chest pain

25. Which of the following drugs should the nurse prepare to administer to a client with a toxic acetaminophen (Tylenol) level?

A. deferoxamine mesylate (Desferal)B. succimer (Chemet)C. flumazenil (Romazicon)D. acetylcysteine (Mucomyst)

26. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?

A. naloxone (Narcan)B. haloperidol (Haldol)C. magnesium sulfateD. chlordiazepoxide (Librium)

27. A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response?

A. "If you continue to talk like that, I'm going to stop speaking to you."B. "You told me you got fired from your last job for missing too many days after taking drugs all night."C. "Tell me more about how it felt to get high."D. "Don't you know it's illegal to use drugs?"

28. The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?

A. Carbonated beveragesB. Aftershave lotionC. ToothpasteD. Cheese

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29. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?

A. Client's physical needsB. Client's safety needsC. Client's psychosocial needsD. Client's medical needs30. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:

A. a postoperative infection.B. alcohol withdrawal.C. acute sepsis.D. pneumonia.

31. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?

A. Phencyclidine (PCP) intoxicationB. Alcohol withdrawalC. Opiate withdrawalD. Cocaine withdrawal

32. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:

A. "You must first stop drinking."B. "Your physician must refer you to this program."C. "Admit you're powerless over alcohol and that you need help."D. "You must bring along a friend who will support you."

33. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:

A. accurately describe the amount consumed.B. underestimate the amount consumed.C. overestimate the amount consumed.D. deny any consumption of alcohol.

34. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes

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piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?

A. Alcohol withdrawalB. Cannibis withdrawalC. Cocaine withdrawalD. Opioid withdrawal35. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:

A. tension and irritability.B. slow pulse.C. hypotension.D. constipation.

36. Which of the following drugs may be abused because of tolerance and physiologic dependence.

A. lithium (Lithobid) and divalproex (Depakote).B. verapamil (Calan) and chlorpromazine (Thorazine)C. alprazolam (Xanax) and phenobarbital (Luminal)D. clozapine (Clozaril) and amitriptyline (Elavil)

37. Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis and hyperactivity. Blood pressure is 190/87 mmhg and pulse is 92 bpm. Which of the medications would the nurse expect to administer? 

A. Naloxone (Narcan)B. Benzlropine (Cogentin)C. Lorazepam (Ativan)D. Haloperidol (Haldol) 

38. In opium ovedose, naloxone is administered as

A. 10 mg IMB. 2 mg IVC. 100 mg orallyD. 5 mg s/c

39. Which of the following is a synthetic derivative of opium?

A. MorphineB. CodeineC. PapaverineD. Heroin

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40. 12. Which of the following is a matching pair?

A. LSD-narcoticB. Heroin-psychotropicC. Amphetamine-stimulantD. Benzodiazepenes-analgesics

Answers and Rationale:

1. C. "You seem upset about the meetings."

Rationale: The substance abuser uses the substance to cope with feelings and may deny the abuse. Asking if the client is upset about the meetings encourages the client to identify and deal with feelings instead of covering them up. Arguing with the client about the substance abuse (option A) or insisting that the client attend the meetings (option D) wouldn't help the client identify resistance to treatment. Option B isn't therapeutic behavior because it plays down the importance of attending meetings.

2. C. jointly by the client and nurse.

Rationale: A contract written jointly by the client and nurse most successfully promotes cooperation and consistent behavior. The most effective contract — and the type least likely to allow for manipulation and misinterpretation — states the behavioral terms as concretely as possible. A contract written solely by the client may not be agreeable to staff members; one written by the physician and nurse may not be agreeable to the client.

3. C. Crucial phase

Rationale: The crucial phase is marked by physical dependence. The prealcoholic phase is characterized by drinking to medicate feelings and for relief from stress. The early phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and preoccupation with alcohol. The chronic phase is characterized by emotional and physical deterioration.

4. C. Have an organized, efficient team approach after the decision is made to restrain the client.

Rationale: Emergency department personnel should use an organized, team approach when restraining violent clients so that no one is injured in the process. The leader, located at the client's head, should take charge; four staff members are required to hold and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame instead of the side rails. For quick release, loops should be used instead of knots

5. B. Nystagmus

Rationale: Phencyclidine is an anesthetic with severe psychological effects. It blocks the reuptake of dopamine and directly affects the midbrain and thalamus. Nystagmus and ataxia are

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common physical findings of PCP use. Dilated pupils are evidence of LSD ingestion. Paranoia and altered mood occur with both PCP and LSD ingestion.

6. D. Denial

Rationale: Denial is an unconscious defense mechanism in which emotional conflict and anxiety are avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Withdrawal is a common response to stress, characterized by apathy. Logical thinking IS the ability to think rationally and make responsible decisions, which would lead the client to admitting the problem and seeking help. Repression is suppressing past events from the consciousness because of guilty association.

7. A. avoid all products containing alcohol.

Rationale: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

8. C. methadone.

Rationale: Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.

9. D. euphoria and constricted pupils.

Rationale: Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.

10. B. Tachycardia

Rationale: Amphetamines are central nervous system stimulants. They cause sympathetic stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin is seen with anticholinergic agents such as jimsonweed. Pupils will be dilated, not constricted.

11. A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output

Rationale: A nurse who lacks adequate information to determine which level of care a client requires must take all possible precautions to ensure the client's physical safety and prevent complications. To do otherwise could place the client at risk for potential complications. After taking all possible precautions, the nurse can begin seeking health history information and, as needed, modify the plan of care. Fluids are typically increased unless contraindicated by a preexisting medical condition.

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12. A. Abstinence is the basis for successful treatment.

Rationale: The foundation of any treatment for alcoholism is abstinence. Attendance at Alcoholics Anonymous is helpful to some individuals to maintain strict abstinence. Participation in treatment by the family is beneficial to both the client and the family but isn't essential. Abstinence requires refraining from social drinking.13. C. nitroglycerin (Nitro-Bid IV).

Rationale: The elevated ST segments in this client's ECG indicate myocardial ischemia. To reverse this problem, the physician is most likely to prescribe an infusion of nitroglycerin to dilate the coronary arteries. Lidocaine and procainamide are cardiac drugs that may be indicated for this client at some point but aren't used for coronary artery dilation. If a cocaine user experiences ventricular fibrillation or asystole, the physician may prescribe epinephrine. However, this drug must be used with caution because cocaine may potentiate its adrenergic effects.

14. B. "Tell me how you feel about the accident."

Rationale: An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. A judgmental approach isn't therapeutic. By giving advice, the nurse suggests that the client isn't capable of making decisions, thus fostering dependency.

15. D. Diaphoresis, tremors, and nervousness

Rationale: Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability. Although diarrhea may be an early sign of alcohol withdrawal, tachycardia — not bradycardia — is associated with alcohol withdrawal. Dehydration and an elevated temperature may be expected, but a temperature above 101° F indicates an infection rather than alcohol withdrawal. Pruritus rarely occurs in alcohol withdrawal. If withdrawal symptoms remain untreated, seizures may arise later.

16. D. nifedipine and esmolol

Rationale: This client requires a vasodilator, such as nifedipine, to treat hypertension, and a beta-adrenergic blocker, such as esmolol, to reduce the heart rate. Lidocaine, an antiarrhythmic, isn't indicated because the client doesn't have an arrhythmia. Although nitroglycerin may be used to treat coronary vasospasm, it isn't the drug of choice in hypertension.

17. D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

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Rationale: According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such use, indicated either by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem caused or exacerbated by substance abuse or recurrent use in dangerous situations (for example, while driving). For this client, psychoactive substance dependence must be ruled out; criteria for this disorder include a need for increasing amounts of the substance to achieve intoxication (option A), increased time and money spent on the substance (option B), inability to fulfill role obligations (option C), and typical withdrawal symptoms.

18. A. Coronary artery spasm

Rationale: Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at postsynaptic receptor sites. Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias. Although neurobehavioral deficits are common in neonates born to cocaine users, they are rare in adults. As craving for the drug increases, a person who's addicted to cocaine typically experiences euphoria followed by depression, not panic disorder.

19. C. begin anytime within the next 1 to 2 days.

Rationale: Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.

20. C. Providing a quiet environment and administering medication as needed and prescribed

Rationale: Manifestations of alcoholic hallucinosis are best treated by providing a quiet environment to reduce stimulation and administering prescribed central nervous system depressants in dosages that control symptoms without causing oversedation. Although bed rest is indicated, restraints are unnecessary unless the client poses a danger to himself or others. Also, restraints may increase agitation and make the client feel trapped and helpless when hallucinating. Offering juice is appropriate, but measuring blood pressure every 15 minutes would interrupt the client's rest. To avoid overstimulating the client, the nurse should check blood pressure every 2 hours.

21. A. Heart rate of 120 to 140 beats/minute

Rationale: Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular

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collapse and most commonly occurs in clients who don't receive treatment. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process.

22. B. The student accepts a referral to a substance abuse counselor.

Rationale: All of the outcomes stated are desirable; however, the best outcome is that the student would agree to seek the assistance of a professional substance abuse counselor.

23. C. lorazepam (Ativan)

Rationale: The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren't used to manage alcohol withdrawal syndrome.

24. A. Al-Anon

Rationale: Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism. Make Today Count is a support group for people with life-threatening or chronic illnesses. Emotions Anonymous is a support group for people experiencing depression, anxiety, or similar conditions. Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.

25. B. total abstinence.

Rationale: Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.

26. A. Seizures

Rationale: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

27. D. acetylcysteine (Mucomyst)

Rationale: The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites. Deferoxamine mesylate is the antidote for iron intoxication. Succimer is an antidote for lead poisoning. Flumazenil reverses the sedative effects of benzodiazepines.

28. D. chlordiazepoxide (Librium)

Rationale: Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Haloperidol (Haldol) may be given to treat clients with psychosis, severe

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agitation, or delirium. Naloxone (Narcan) is administered for narcotic overdose. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

29. B. "You told me you got fired from your last job for missing too many days after taking drugs all night."

Rationale: Confronting the client with the consequences of substance abuse helps to break through denial. Making threats (option A) isn't an effective way to promote self-disclosure or establish a rapport with the client. Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse (option C). Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. The client undoubtedly is aware that drug use is illegal; a reminder to this effect (option D) is unlikely to alter behavior.

30. B. Aftershave lotion

Rationale: Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Carbonated beverages, toothpaste, and cheese don't contain alcohol and don't need to be avoided by the client.

31. B. Client's safety needs

Rationale: The highest priority for a client who has ingested PCP is meeting safety needs of the client as well as the staff. Drug effects are unpredictable and prolonged, and the client may lose control easily. After safety needs have been met, the client's physical, psychosocial, and medical needs can be met.

32. B. alcohol withdrawal.

Rationale: The client's vital signs and hallucinations suggest delirium tremens or alcohol withdrawal syndrome. Although infection, acute sepsis, and pneumonia may arise as postoperative complications, they wouldn't cause this client's signs and symptoms and typically would occur later in the postoperative course.

33. C. Opiate withdrawal

Rationale: Clonidine is used as adjunctive therapy in opiate withdrawal. Benzodiazepines, such as chlordiazepoxide (Librium), and neuropleptic agents, such as haloperidol, are used to treat alcohol withdrawal. Benzodiazepines and neuropleptic agents are typically used to treat PCP

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intoxication. Antidepressants and medications with dopaminergic activity in the brain, such as fluoxotine (Prozac), are used to treat cocaine withdrawal.

34. C. "Admit you're powerless over alcohol and that you need help."

Rationale: The first of the "Twelve Steps of Alcoholics Anonymous" is admitting that an individual is powerless over alcohol and that life has become unmanageable. Although Alcoholics Anonymous promotes total abstinence, a client will still be accepted if he drinks. A physician referral isn't necessary to join. New members are assigned a support person who may be called upon when the client has the urge to drink.

35. B. underestimate the amount consumed.

Rationale: Most people who abuse substances underestimate their consumption in an attempt to conform to social norms or protect themselves. Few accurately describe or overestimate consumption; some may deny it. Therefore, on admission, quantitative and qualitative toxicology screens are done to validate information obtained from the client.

36. D. Opioid withdrawal

Rationale: The symptoms listed are specific to opioid withdrawal. Alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannibis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

37. A. tension and irritability.

Rationale: An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Options B and C are incorrect because amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Diarrhea is a common adverse effect, so option D is incorrect.

38. C. Benzlropine (Cogentin).

Rationale: The nurse would most likely administer benzodiazepine, such as lorazepan (ativan) to the client who is experiencing symptom: The client’s experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease.

39. D. Heroin.

Rationale: Heroin is a derivative of Opium.

40. C. Amphetamine – Stimulant.

Rationale: Options A, B and D are mismatched according to their drug classifications.

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