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The client explains that they have recently been diagnosed with a problem related to substances and was told it is “a substance use disorder.” When describing this issue to the client, which information would the nurse integrate into the response?
A. Substance use disorder means physiologic and psychological dependence on alcohol or other drugs that affect the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued.
B. Because this is not information that the nurse can give to the client, the nurse should refer the client to the health care provider for more information.
C. Substance use disorder means the person has a maladaptive pattern of use that shows physiologic, cognitive, and behavioral indications that the person continues to use the substance despite the resulting negative effects.
D. Substance use disorder means that the client consciously or unconsciously helps the maladaptive behavior related to substance use to continue.
Answer: C
Rationale: Substance use disorder is a maladaptive pattern of substance use that demonstrates physiologic, cognitive, and behavioral indications that the person continues to use the drug despite the adverse substance-related problems they may be experiencing. There is evidence of compulsive drug-seeking behaviors. Addiction is a physiologic and psychological dependence on a substance to the extent that withdrawal symptoms are experienced when the substance is discontinued. To refer the question to the health care provider is inappropriate since the nurse can provide an effective answer to the question. A pattern of either consciously or unconsciously helping the maladaptive behavior to continue is referred to as enabling.
A mental health nurse is providing an educational event on substance use disorder for the parent organization at the local high school. Which topic should the nurse include to address the social impact of this problem?
A. The violence associated with the drug cartels in other countries
B. Why marijuana should not be legalized
C. Research results on the medical use of marijuana
D. The public burden created by drug-related criminal behaviors
Answer: D
Rationale: Society is additionally burdened by drug-related criminal behaviors that involve both the participation in usage and the sale of drugs and the violence associated with the drug industry and this is an appropriate topic to include in the presentation. There tends to be an increase in encounters with disciplinary authorities as a result of substance use-related behaviors (e.g., arrests for disorderly conduct, public intoxication, driving while intoxicated, suspension or expulsion from school, involvement of child protective services). Marijuana legalization should not be included because the information would be based on the nurse's personal opinion. Research about the medical use of marijuana is “nice-to-know” information, but it would not address the societal impact. The violence associated with drug cartels is not a local issue.
A client has completed the detoxification process associated with a dependency treatment program for alcohol. The nurse documents that the client is no longer demonstrating any signs or symptoms of alcohol intoxication or withdrawal. Which additional documentation is required to confirm that the client has successfully met the acute withdrawal outcomes for treatment?
A. Client is capable of meeting basic personal needs without assistance.
B. Client sustained no physical trauma as a result of the withdrawal process.
C. Client has insight into the personal triggers that bring about alcohol use.
D. Client is scheduled to enter a 6-month residential treatment program on discharge.
Answer: B
Rationale: Acute withdrawal outcomes are achieved when the client no longer exhibits any signs or symptoms of substance intoxication or withdrawal and has sustained no injuries during the detoxification period. Meeting personal needs, demonstrating insight into the addiction, and seeking advanced treatment are not outcomes of the acute withdrawal period, which focuses on the physical and psychological effects of the abused substance.
A mental health nurse is gathering data from an adolescent with a substance use problem. The nurse understands that during this developmental period, which etiologic factor would play the greatest role in contributing to the client's condition?
A. Family history
B. Genetics
C. Peer pressure
D. Gang violence
Answer: C
Rationale: Adolescence is a time when new things are exciting and peer pressure is at its highest. Teenagers may get involved with substances for various reasons, and experimentation is common. They often do not see the connection between their present actions and the consequences these actions may impose. Family history and genetics are not at their “highest” during adolescence. Gang violence is not typically an etiologic factor in substance use disorder.
A nurse is assisting in developing the plan of care for a client exhibiting substance use behaviors. When reviewing the client's family history, which action would the nurse identify as an example of how the client's family unintentionally contributes to the continuation of the client's substance-use behaviors?
A. They exhibit fearful behaviors when the substance user is not around.
B. They display defensive actions to excuse the behavior of the drug user.
C. They assume responsibility for the problem.
D. They begin to enable the substance use to maintain contact with the abuser.
Answer: B
Rationale: Families often display defensive actions that in a way normalize and excuse the behavior of the drug user and thus unintentionally increase the likelihood that the substance use pattern will continue. The other options may exist, but they are not unintentionally acted upon by the family.
The spouse of a client with alcohol use disorder is attending an Al-Anon meeting. The spouse asks, “What does codependency mean?” Which response by the nurse would be most appropriate?
A. “An agreement among family members that suppresses the anger and emotional pain caused by the addiction.”
B. “A set of behaviors that help make the family members and the addict feel safe and secure.”
C. “A pattern of making allowances for the person who uses so life is easier for all members of the family.
D. “An unconscious supporting of the substance user’s behaviors by family members.”
Answer: C
Rationale: People who are codependent tend to feel a responsibility for the person with a substance use disorder’s problem and internalize a form of guilt for the behavior of that person. As a result, they continue to do everything possible to sustain the relationship and are unable to recognize the detrimental effects of the codependency on their own physical and mental health. Codependent people deny their own needs while living and doing for another what they need to do for themselves. People in this situation learn to tolerate and excuse the maladaptive behavior. This pattern of either consciously or unconsciously helping the maladaptive behavior to continue is referred to as enabling. The person who is enabling this behavior commonly makes excuses or lies to others about behaviors related to the substance use. The codependent person learns to make allowances for the person who uses in order to make life easier for all members of the family. This behavior allows the person who uses substances to maintain a perceived sense of control over their dependency and provides a false permission for the addiction to continue. The other options do not fully explain the concept of codependency.
When reviewing the history of a client with a substance use disorder, the nurse notes behaviors suggesting guilt associated with codependency of several family members. Which finding would the nurse identify as key in these family members?
A. Physiologic symptoms that negatively impact their health
B. The ability to recognize the detrimental effects of their codependency
C. Mental health problems such as depression
D. Behaviors aimed at sustaining the relationship
Answer: D
Rationale: People who are codependent tend to feel a responsibility for the problem of the substance user and internalize a form of guilt for the behavior of that person. As a result, they continue to do everything possible to sustain the relationship and are unable to recognize the detrimental effects of the codependency on their own physical and mental health. Codependency may result in physical and/or mental health symptoms for the codependent person, but these do not occur in all cases nor are they necessarily a result of the sense of guilt.
When developing long-term sobriety goals for a client with substance use disorder, the nurse would focus actions on achieving which outcome as the priority?
A. Client will live a substance-free full and productive life as a member of society.
B. The client and family will engage in actions to heal family differences.
C. Client will participate in setting long-term life goals.
D. Client and family will function outside the previous codependent behaviors.
Answer: A
Rationale: After the withdrawal period, nursing interventions contribute to the long-term treatment goals. Efforts are directed to help the client live a full and productive life as a member of society without the use of the substance. The remaining options are limited to addressing only portions of the goal of long-term sobriety.
A client is hospitalized for substance intoxication. Which data would be a priority during the admission assessment?
A. Genetic factors
B. Client’s perception of the admitting problem
C. Drug use history
D. Family history of substance use
Answer: C
Rationale: During the acute stage following admission for treatment, the nursing assessment is first directed toward obtaining data regarding substance use which is then used for planning interventions for a safe withdrawal phase. The detoxification phase will leave the client free of the substance with the potential to confront the problem. While the other options are foci of the assessment, they are not the priority since that information is not as directly associated with the client’s status and treatment planning.
A nurse is using the CAGE questionnaire screening tool. The nurse is attempting to gather information about which area?
A. Use of physical violence
B. The client's perception of current problem
C. Knowledge of substance use
D. Alcohol dependency
Answer: D
Rationale: The CAGE questionnaire is often used to screen for alcohol dependency. The CAGE questionnaire does not screen for the use of physical violence, the client's perception of the current problem, or the client's knowledge of substance use. Since it was first introduced, the CAGE questionnaire has also been adapted to apply to other substances and is referred to the CAGE-AID questionnaire.
A client who is intoxicated is admitted through the emergency department after being found passed out on the sidewalk. Which nursing care focus would most likely apply for this client?
A. Risk for injury
B. Ineffective family coping
C. Ineffective denial of problem
D. Sleep pattern disturbance
Answer: A
Rationale: A priority nursing care focus for a client who is intoxicated would be risk for injury. Related risk factors include impaired judgment, increase in risk-taking behaviors, substance withdrawal, seizures, delirium, flashbacks, anger, and agitation. The scenario described does not indicate ineffective family coping, excessive and ineffective denial of problem, or a sleep pattern disturbance.
When developing a plan of care for a client identified with substance-use issues, the nurse identifies an appropriate nursing care focus. Which area would the nurse identify as initially problematic?
A. Dependence on codependent family behaviors
B. Ability to function in ADLs
C. Knowledge of the current problem
D. Desire to discontinue the use of the substance
Answer: B
Rationale: Once the assessment data have been collected, the registered nurse identifies problems that result from the client's substance dependence and its effect on their ability to function in activities of daily living. Nursing care foci are not drawn initially from the client's dependence on codependent family behaviors, the client's knowledge of the current problem, or the client's desire to discontinue the use of the substance.
A client with substance use disorder is in the recovery phase and striving for sobriety. Which outcome would be most appropriate to address continued sobriety?
A. Client recognizes that problems may occur with the use of the substance.
B. Client recognizes that external factors are not always the cause for substance use.
C. Client identifies codependent behaviors in the immediate family.
D. Client takes ownership of the identified problem of substance use.
Answer: D
Rationale: An expected outcome that addresses the planning strategies for continued sobriety and abstinence from substance use is that the client identifies the drug as a problem and takes ownership of the problem. The remaining options do not address the need for self-reflection regarding ownership of the problem for continued sobriety.
The nurse is talking with a client who has a diagnosis of substance use disorder. The client states, “I don't know what to do to handle the stress in my life that makes me want to take these substances.” Based on the client's statement, which expected outcome should the nurse identify when updating the client's plan of care?
A. Identifies alternative coping mechanisms
B. States understanding of substance use disorder
C. Demonstrates increased feelings of self-worth
D. Demonstrates efforts at positive change
Answer: A
Rationale: An expected outcome that addresses the planning strategies for continued sobriety and abstinence from substance use is that the client identifies alternative coping mechanisms to use in response to stress instead of the substance. The other responses do not address the client's stated concern.
A client is in the recovery phase of treatment for substance use disorder. The nurse determines that the client is achieving the expected outcome based on which data?
A. Identifies methods to decrease anxiety and promote relaxation
B. Begins to develop a support system with nonsubstance-using friends
C. Promotes a restful sleep pattern through effective sleep hygiene methods
D. Prevents seizures through medication compliance
Answer: B
Rationale: An expected outcome for a client in the recovery phase of substance-use disorder treatment is that the client begins to develop or reestablish a support system with family, employer, and nonsubstance-using friends. The remaining options are appropriate for the acute phase.
A client with chronic alcohol use disorder is undergoing detoxification. The client asks the nurse, “Why do I need to take this niacin and thiamine replacement?” Which response by the nurse would be most appropriate?
A. “Your chances for developing cirrhosis will be less.”
B. “This supplement will help heal the bleeding vessels in your esophagus.”
C. “It will help to prevent neurologic problems from chronic alcohol use.”
D. “It helps to control the excess amount of acid you have in your stomach.”
Answer: C
Rationale: Multivitamin therapy and thiamine replacement therapy are used to prevent neuropathy and encephalopathy from chronic alcohol use (Wernicke–Korsakoff syndrome), because clients with chronic alcohol use are usually deficient in thiamine and niacin. Cirrhosis and esophageal varices cannot be prevented by or healed with multivitamin therapy and thiamine replacement. Zollinger–Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Thiamine and niacin replacement would have no effect on this condition.
A client is being treated in a detoxification setting for opioid use. To minimize withdrawal symptoms, the nurse anticipates which medication will be prescribed?
A. Disulfiram
B. Naloxone
C. Phenytoin
D. Clonidine
Answer: D
Rationale: Opioid withdrawal symptoms can be minimized with clonidine in a detoxification setting. This agent lowers blood pressure, so it is essential to monitor vital signs closely during the withdrawal period. Disulfiram is used to treat long-term alcohol use. The medication inhibits alcohol ingestion by producing severe adverse effects if alcohol is ingested. Phenytoin is an antiseizure medication. Naloxone is a narcotic agonist.
A client is experiencing acute substance withdrawal. When assisting with developing the client’s plan of care, at which frequency would the client’s vital signs be monitored during the first 3 to 4 days of withdrawal?
A. Every 1 to 2 hours
B. Every 2 to 4 hours
C. Every 8 hours
D. Every shift
Answer: A
Rationale: Nursing interventions during acute substance withdrawal may include monitoring vital signs every 1 to 2 hours during the first 3 to 4 days of withdrawal.
When caring for a client with substance-use issues, the nurse determines that the client has made progress based on which information?
A. Whether or not the client has relapsed
B. Client’s achievement of anticipated outcomes
C. Client’s recognition of their responsibilities
D. The phase of the treatment process
Answer: B
Rationale: The evaluation process will depend on the anticipated outcome since outcomes will be reflective of the phase of recovery the client is in. It will not depend on the phase of the treatment process, whether the client recognizes their responsibilities or whether the client has relapsed.
A mental health nurse is attending an in-service education program about substance use. The nurse demonstrates understanding of the information when the nurse identifies which factor as playing a major role in the onset and continued use of alcohol and other substances?
A. Poor morals
B. Cognitive disorders
C. Poor ethics
D. Stress
Answer: D
Rationale: Stress is cited as a major factor in the initiation and continued use of alcohol and other substances. It is a significant factor when the person relapses and returns to a pattern of self-destructive behaviors. The other options have not been proven to be factors in the onset or continued use of either alcohol or other substances.
Research has shown that social learning involves imitation, the effects of modeling, and identification behaviors. Which statement(s) best explain the results of this research in the etiology of substance use disorder? Select all that apply.
A. Children of substance-abusing parents are at a greater risk for substance use disorder.
B. Social learning involves the effects of modeling, imitative, and identification behaviors.
C. Genetics plays a minor role in the development of substance-use behaviors.
D. Chaotic home environments increase the likelihood of substance-use issues.
E. The risk for alcohol use is decreased in first-generation relatives of those with alcohol use disorder.
Answer: A, B, D
Rationale: Social learning involves the effects of modeling, imitative, and identification behaviors that begin at an early age. Children of substance-using parents are at a greater risk for substance use and subsequent problems because of both genetic and environmental factors. There is an apparent link between heredity and the development of substance-use disorders and this is especially true for alcohol use disorder. Research also shows that the younger a person is when substance usage begins, the greater the probability that it will progress to excessive use and addiction. Chaotic home environments and association with peers who engage in substance-related behaviors also increase the likelihood that this will occur. This scenario is often accompanied by weak parent–child attachment with ineffective parenting and hostile, troubled relationships.
When gathering data from a client with substance use disorder, the nurse notes characteristics of the client’s personality. When reviewing the client’s characteristics, which characteristic would the nurse identify as playing a role in the development of the client’s problem? Select all that apply.
A. Difficulty expressing feelings
B. Feelings of emotional isolation
C. Gregariousness
D. Timidity
E. Low frustration tolerance
Answer: A, B, E
Rationale: Most people with substance use disorders have difficulty expressing feelings and may release these explosively as the substance used diminishes their ability to control them. Feelings of emotional isolation and a low frustration tolerance are further indicators of the need to borrow a feeling of strength and security from an external substance. Extremes of social expression, gregariousness, or timidity have not been shown to be characteristics that contribute to the etiology of substance use disorder.
A nurse is reviewing the plan of care for a client with substance use disorder. Which statement(s) would the nurse identify as reflecting expected outcomes specifically focused toward long-term sobriety? Select all that apply.
A. Client verbalizes understanding of illness and the recovery process.
B. Client demonstrates relaxation with decreased anxiety.
C. Client exhibits a willingness to participate in a group recovery treatment program.
D. Client identifies necessary lifestyle changes.
E. Client identifies nonsubstance-focused coping mechanisms.
Answer: A, C, D, E
Rationale: Expected outcomes that address the planning strategies for continued sobriety and abstinence from substance use are that the client demonstrates willingness to participate in a group recovery treatment program, verbalizes understanding of illness, and identifies lifestyle changes and coping mechanisms that are all specific to sobriety. The outcome of decreasing anxiety through relaxation is general in its focus and not directed to continued sobriety.
The mental health nurse is conducting an assessment interview with a client diagnosed with alcohol use disorder. The nurse would focus this initial data gathering which area(s)? Select all that apply.
A. When alcohol was first used excessively
B. Type of alcohol being used
C. Amount of alcohol being used
D. When alcohol was last used
E. Length of time between uses
Answer: A, B, C, D
Rationale: The assessment interview should be directed toward identifying the type of substance the person has been using, the amount and frequency of use, the last time substance was used, the method of administration, and the length of time the substance has been used. It is not important in the initial interview to elicit information on the length of time between uses.
The nurse is evaluating client outcomes for a client who has gone through the acute withdrawal phase. Which criteria would the nurse use to indicate outcome achievement? Select all that apply.
A. Client has not demonstrated behaviors indicating a relapse.
B. Client has recognized the problem and taken ownership of it.
C. Client exhibits no signs or symptoms of substance intoxication.
D. Client has sustained no injuries during the detoxification period.
E. Client exhibits no signs or symptoms of substance withdrawal.
Answer: C, D, E
Rationale: Acute withdrawal outcomes are achieved when the client no longer exhibits any signs or symptoms of substance intoxication or withdrawal and has sustained no injuries during the detoxification period. The remaining options are expected outcomes for the recovery phase, not the acute phase.