1. Basics of Addiction & Substance Use
Q: This term describes a chronic, relapsing condition involving compulsive use of a substance despite harmful consequences.
A: What is addiction?
Q: This term describes drugs like morphine and hydromorphone that fully activate opioid receptors.
A: What are opioid agonists?
Q: This term refers specifically to problematic use of opioids that leads to clinically significant impairment or distress.
A: What is opioid use disorder?
Q: The first priority in caring for a patient with suspected substance use is always this.
A: What is ensuring safety (of the patient and others)?
Q: Prescription drug misuse generally refers to using a prescribed medication in any way other than this.
A: What is as prescribed (by the prescriber)?
Q: This term refers to the physiological process in which the body adapts to a drug, leading to withdrawal symptoms if the drug is stopped.
A: What is physical dependence?
Q: This type of opioid receptor is primarily responsible for analgesia and euphoria but also for respiratory depression.
A: What are mu receptors?
Q: Name one common opioid withdrawal symptom.
A: What is (any one) muscle aches, runny nose, tearing, yawning, gooseflesh, abdominal cramps, nausea/vomiting, diarrhea, anxiety, or dilated pupils?
Q: Current guidance for addressing substance use in nurses emphasizes this non‑punitive approach to encourage reporting and treatment.
A: What is a just culture or a supportive, non‑punitive approach?
Q: Prescription monitoring programs often focus on “monitored drugs.” Name one major class of medications that is commonly monitored.
A: What are (any one) opioids, benzodiazepines, stimulants, or certain controlled sedatives?
Q: These two key features distinguish substance use disorder from casual substance use.
A: What are impaired control and continued use despite harm?
Q: This class of drugs both activates some opioid receptors and blocks others (e.g., buprenorphine, nalbuphine).
A: What are opioid agonist–antagonists (or partial agonists)?
Q: Medications such as methadone or buprenorphine/naloxone are part of this first‑line pharmacologic treatment for opioid use disorder.
A: What is opioid agonist therapy (OAT) or opioid agonist treatment?
Q: Signs of prescription misuse in the workplace can involve medication handling. Name two possible behaviours that might indicate a nurse is misusing prescription medications at work.
A: What are (any two) frequent wasting or discrepancies in narcotic counts, volunteering to give others’ narcotic meds, patients complaining of inadequate pain relief, spending excessive time near medication storage, or unexplained absences around medication times?
Q: Name one risk associated with long‑term prescription opioid therapy for chronic non‑cancer pain.
A: What is (any one) dependence, opioid use disorder, overdose, opioid‑induced hyperalgesia, decreased function, or diversion?
Q: Psychoactive substances are commonly grouped into these three major categories.
A: What are depressants, stimulants, and hallucinogens?
Q: This opioid antagonist is used in emergencies to reverse opioid overdose.
A: What is naloxone?
Q: Before starting or continuing methadone, name two key nursing assessment points.
A: What are (any two) current opioid use pattern, time and amount of last opioid dose, level of sedation or withdrawal, use of other sedatives/alcohol, risk factors for QT prolongation or cardiac disease, and concurrent medical conditions?
Q: When a manager suspects a nurse has problematic substance use, name two immediate actions that should be taken.
A: What are (any two) ensuring immediate patient safety, removing the nurse from unsafe duties, documenting concerns objectively, consulting occupational health/HR/regulatory body, or initiating a supportive referral for assessment and treatment?
Q: Diversion is the movement of prescription drugs into illegal or non‑medical channels. Name two ways prescription opioids may be diverted from legitimate to illicit use.
A: What are (any two) doctor shopping, forged prescriptions, theft from pharmacies or homes, sharing medications with family or friends, or selling prescribed medication?
Q: Name two changes in the brain’s reward pathway that help explain why substance use disorders are chronic and relapsing.
A: What are (any two) changes in dopamine transmission, altered reward circuitry sensitivity, or neuroadaptation in the mesolimbic pathway?
Q: Long‑acting opioids carry particular risks. Name two safety considerations when prescribing or administering long‑acting opioids.
A: What are (any two) avoiding use in opioid‑naïve patients, risk of accumulation and delayed respiratory depression, not crushing/chewing, and careful titration and monitoring?
Q: Motivational interviewing is often used with patients with opioid use disorder. Name two core techniques or principles of motivational interviewing.
A: What are (any two) expressing empathy, developing discrepancy, rolling with resistance, supporting self‑efficacy, using open‑ended questions, affirmations, reflective listening, or summarizing?
Q: From an ethical standpoint, nurses must balance patient or colleague confidentiality with this duty when substance use poses a risk.
A: What is the duty to protect the public/patient safety (or the duty to report)?
Q: Prescription monitoring programs are used by prescribers and pharmacists. Name two ways nurses can apply the principles of these programs in their own practice.
A: What are (any two) advocating for monitoring checks when there are concerns, collaborating with prescribers and pharmacists, carefully documenting pain and response, monitoring for red flags (early refills, lost prescriptions), and educating patients about safe storage and disposal?