Chapter 17: Substance Use Disorder

Multiple Choice

1. A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct?

a. “It’s possible that these cravings will never stop.” b. “These cravings may persist for several months.” c. “The cravings tell us that you are still using nicotine.” d. “The cravings show that you are about to experience nicotine withdrawal.”

ANS: B

Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. Diazepam (Valium) b. Methadone c. Disulfiram (Antabuse) d. Bupropion (Zyban)

2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment?

ANS: B

Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation.

DIF: COGNITIVE LEVEL: Remembering (Knowledge)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Naltrexone prevents the cravings for opioid drugs. b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost.

3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient?

ANS: D

Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Cocaine b. Flunitrazepam c. Secobarbital d. Methamphetamine

4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is the slang term for which substance?

ANS: B

Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the “date-rape” drug). The other drugs are not known as roofies.

DIF: COGNITIVE LEVEL: Remembering (Knowledge)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Opioids b. Alcohol c. Stimulants d. Depressants

5. A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance?

ANS: C

The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Renal failure b. Cerebrovascular accident c. Korsakoff’s psychosis d. Alzheimer’s disease

6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition?

ANS: C

A variety of serious neurologic and mental disorders, such as Korsakoff’s psychosis and Wernicke’s encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer’s disease are not associated directly with chronic use of alcohol.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. He should not smoke cigarettes while on this drug. b. He needs to know about the common over-the-counter substances that contain alcohol. c. This drug will cause the same effects as the alcohol did, without the euphoric effects. d. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.

7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy?

ANS: B

The use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicit severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine. b. Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. c. Compliance with treatment is higher with use of the gum rather than the transdermal patch. d. The nicotine gum can be used only up to six times per day.

8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true?

ANS: A

Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.)

a. This drug is available as a chewing gum that can be taken to reduce cravings.

b. Use caution when driving because drowsiness may be a problem.

c. There have been very few adverse effects reported for this drug.

d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.

e. Avoid caffeine while on this drug.

ANS: B, D

Patients taking varenicline have reported drowsiness, which has prompted the U.S. Food and Drug Administration (FDA) to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Euphoria b. Severe vomiting c. Diarrhea d. Pulsating headache e. Difficulty breathing f. Sweating

2. A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.)

ANS: B, D, E, F

Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy. Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness, weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not adverse effects associated with acetaldehyde syndrome.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. Agitation b. Drowsiness c. Tremors d. Systolic blood pressure higher than 200 mm Hg e. Temperature over 100° F (37.7° C) f. Pulse rate 110 beats/min

3. The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.)

ANS: A, C, D

Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Chapter 18: Adrenergic Drugs

Multiple Choice

1. The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?

a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

ANS: C

Adrenergic drugs mimic the effects of the sympathetic nervous system.

DIF: COGNITIVE LEVEL: Remembering (Knowledge)

TOP: NURSING PROCESS: General

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

2. When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?

ANS: A

An increased force of contraction is known as a positive inotropic effect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: General

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

3. When a patient is taking an adrenergic drug, the nurse expects to observe which effect?

ANS: A

Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety

4. An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?

ANS: B

For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase cardiac output. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia

5. The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?

ANS: C

Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. She is experiencing normal adverse effects of dobutamine therapy. b. She may be experiencing an allergic reaction to the dobutamine. c. The medication may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine needs to be increased to control the symptoms better.

6. A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse’s immediate concern for this patient?

ANS: C

Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may worsen a pre-existing cardiac disorder, such as causing a myocardial infarction in a patient with coronary artery disease. The other options are incorrect.

DIF: COGNITIVE LEVEL: Analyzing (Analysis)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “It takes time for a therapeutic response to develop.” b. “She is too young for this particular medication; it will be changed.” c. “She needs to take up to two puffs every 4 hours to ensure adequate blood levels.” d. “This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms.”

7. A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate?

ANS: D

Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Ephedra b. Epinephrine c. Phenylephrine d. Pseudoephedrine

8. A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?

ANS: B

Epinephrine is the drug of choice for the treatment of anaphylaxis. The other drugs listed are incorrect choices.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Dopaminergic b. Beta1 adrenergic c. Beta2 adrenergic d. Alpha1 adrenergic

9. The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?

ANS: C

Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

10. The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine?

ANS: D

Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.)

a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis

ANS: A, D, E, G

Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Completion

1. The nurse is to administer epinephrine 0.3 mg subcutaneously. The ampule contains 1 mL of medication and is labeled “Epinephrine 1:1000.” Identify how many milliliters of epinephrine will the nurse give. _______

ANS: 0.3 mL

Note that 1:1000 indicates 1 gram per 1000 mL or 1000 mg per 1000 mL, which is a concentration of 1 mg/mL.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies