[Osborn] chapter 16 Learning Outcomes [Number and Title] Learning Outcome 1 Explain the major theories about substance-related disorders. Learning Outcome 2 List why some groups are at risk for substance-related disorders. Learning Outcome 3 Discuss how the physical, psychological, and withdrawal effects of the major categories of substances manifest themselves. Learning Outcome 4 Incorporate nursing assessment components to detect patients who have substance- related disorders. Learning Outcome 5 Demonstrate knowledge of a variety of short-term and long-term nursing intervention strategies for clients who have substance-related disorders. Learning Outcome 6 Develop outcome criteria for clients who have substance-related disorders. Learning Outcome 7 Establish what impact your own feelings and attitudes about clients with substance-related disorders have on your nursing care. Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice Copyright 2010 by Pearson Education, Inc.
Transcript
[Osborn] chapter 16
Learning Outcomes [Number and Title] Learning Outcome 1 Explain the major theories about substance-related disorders.Learning Outcome 2 List why some groups are at risk for substance-related
disorders.Learning Outcome 3 Discuss how the physical, psychological, and withdrawal
effects of the major categories of substances manifest themselves.
Learning Outcome 4 Incorporate nursing assessment components to detect patients who have substance-related disorders.
Learning Outcome 5 Demonstrate knowledge of a variety of short-term and long-term nursing intervention strategies for clients who have substance-related disorders.
Learning Outcome 6 Develop outcome criteria for clients who have substance-related disorders.
Learning Outcome 7 Establish what impact your own feelings and attitudes about clients with substance-related disorders have on your nursing care.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
1. The nurse is assessing a patient with a substance-related disorder. Which of the following personality characteristics are most often seen in substance disorders?
1. Anxious and irritable2. Introverted and shy3. Satisfied with present life situation and alert4. Pleasant and calm
Correct Answer: Anxious and irritable
Rationale: Anxiety and irritability are personality characteristics associated with substance abuse. Extroverted behavior, rather than introverted, is more associated with substance abuse. Persons with substance abuse are found to be less satisfied with their present life situation and are more easily fatigued than are those without substance abuse. Persons with substance abuse are less pleasant and tend to act rashly when distressed.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
2. A patient tells the nurse that as long as he has his “bag of weed,” he does not need anything else. The nurse realizes this patient is describing:
1. The drug as a partner in a relationship.2. Behavior learned from friends.3. The use of drugs to avoid side effects of medications.4. How the drugs make him feel smarter.
Correct Answer: The drug as a partner in a relationship.
Rationale: According to the psychosocial theory of drug use, the substance abuser may develop an attachment to the drug much like an attachment to another person. The patient’s drug use may or may not be learned from friends. The nurse does not have enough information to know if the patient is taking the drug to avoid side effects of medications or if the drugs make him feel smarter.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
3. A patient tells the nurse that he does not want to attend his wife’s family events because he is expected to drink alcohol and he prefers not to. The nurse realizes this patient is describing behaviors found within the __________ theory of substance disorders.
Rationale: In a sociocultural framework, the roles different family members play and the importance of family rituals contribute to the problem of substance abuse and its treatment. The wife’s family has events where those in attendance are expected to drink, contrary to the patient’s preference. The biological theory supports a biological explanation for substance abuse. The psychological theory explains how the psychological underpinnings of experiences and behaviors come together to form motivation to use drugs in a destructive manner. There is no metaphysical theory for substance abuse.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
4. The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. The nurse realizes that:
1. The patient’s biological parents might have abused alcohol.2. The patient spent time drinking with friends.3. Consuming alcohol is a symptom of stress.4. Alcoholism is a learned behavior.
Correct Answer: The patient’s biological parents might have abused alcohol.
Rationale: Substance abuse prior to conception and during pregnancy has a significant biological impact that can damage the genetic makeup of the child. Research notes that children of people who abuse alcohol have four times the risk of abusing alcohol themselves. There is no evidence to support that the patient is spending time drinking with friends or the patient is consuming alcohol as a symptom of stress. There is also not enough evidence to support this patient’s alcohol use as being a learned behavior.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
5. A young adult patient tells the nurse that he periodically uses “uppers” to keep awake while studying for college classes, so he does not understand why he has been feeling so depressed lately. The nurse realizes this patient is describing:
1. Symptoms of a “crash.”2. Expected effects of the drug.3. Abstinence syndrome.4. Hallucinations.
Correct Answer: Symptoms of a “crash.”
Rationale: Amphetamines or “uppers” are used to control appetite, treat depression, and increase alertness. The patient uses the drug to keep alert to study. Tolerance for amphetamines develops rapidly, and withdrawing the substance can lead to a depressive episode or a “crash.” Depression is not an expected effect of amphetamines. Abstinence syndrome is seen in patients who use cocaine. Hallucinations are associated with drugs such as peyote and LSD.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
6. A patient is admitted with a history of cocaine and alcohol abuse. The nurse realizes that this patient is prone to also having an addiction to which of the following substances?
Rationale: People with substance abuse problems have higher rates of smoking and show a lack of responsiveness to smoking cessation treatments. There is no evidence to suggest that people who use cocaine and alcohol are prone to caffeine, methamphetamine, or amphetamine abuse.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
7. A patient tells the nurse that he avoids all narcotic pain medications because he has experienced “flashbacks” while taking them. The nurse realizes this patient is most likely describing the effects of:
1. LSD.2. Cocaine.3. Marijuana.4. Alcohol.
Correct Answer: LSD.
Rationale: Flashbacks are a spontaneous reliving of the experiences the person felt while under the influence of the drug, even though the person is currently drug free. Flashbacks occur less frequently over time and may be induced by stress, fatigue, and drug or alcohol ingestion. Flashbacks are not typically associated with cocaine, marijuana, or alcohol abuse.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
8. The nurse realizes the patient is describing tolerance when the patient states:
1. “I seem to need an increasing amount of alcohol each evening just to unwind.” 2. “I think I have the flu. My stomach is upset and my hands are shaking.”3. “If I have my drink before I go home, I don’t lose my patience so easily.”4. “I had a really good time at the party. At least my friends told me I did, but I don’t
remember much of it.”
Correct Answer: “I seem to need an increasing amount of alcohol each evening just to unwind.”
Rationale: Tolerance is a cumulative state in which a particular dose of the chemical elicits a smaller response than before. With increasing tolerance, the individual needs higher and higher doses to obtain the desired effects. Withdrawal symptoms of alcohol include nausea, vomiting, gastritis, headache, irritability, and the shakes. Substance abuse is a term used to describe a physical and psychological dependency on a substance to escape stress or change behavior. Overdose symptoms are the physical and/or psychological effects of ingesting too much of the substance at once.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
9. The family of a patient who is admitted for detoxification for an amphetamine addiction is concerned that the patient is excessively fatigued and very depressed. Which of the following is the most appropriate response to the family’s concerns?
1. “The staff is monitoring his condition regularly for behaviors that require additional care.”
2. “Has he ever been suicidal before?”3. “These are normal behaviors during amphetamine withdrawal.”4. “Would you like me to talk to his doctor about your concerns?”
Correct Answer: “The staff is monitoring his condition regularly for behaviors that require additional care.”
Rationale: A “crash” from amphetamine abuse may last for weeks and is often associated with suicidal symptoms. Reassuring the family that the staff is regularly monitoring the patient to evaluate the need for additional care is the most appropriate response to help alleviate their concerns. While the remaining questions or statements may be appropriate, they do not directly address the family’s concerns.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
10. A patient involved in a minor accident reports taking Xanax prior to the accident. Which of the following should the nurse assess in this patient?
1. Alteration in vital signs and diaphoresis2. Sense of increased strength 3. Paranoia4. Hallucinations of grandeur
Correct Answer: Alteration in vital signs and diaphoresis
Rationale: Xanax is a benzodiazepine that produces the same withdrawal symptoms as barbiturate withdrawal. Onset of withdrawal can occur within 24 to 72 hours of the last dose and symptoms include alterations in vital signs and diaphoresis. Crank, a form of methamphetamine, will cause the patient to feel a sense of increased strength and intelligence. Paranoia and hallucinations of grandeur are not associated with benzodiazepine withdrawal.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
11. The nurse observes a patient exhibiting excessive lacrimation, rhinorrhea, yawning, and diaphoresis. The nurse recognizes that these findings suggest that the patient is experiencing withdrawal from:
Rationale: Initial withdrawal symptoms from heroin include drug craving, lacrimation, rhinorrhea, yawning, and diaphoresis, which last up to 10 days since the last dose of the drug. Lacrimation, rhinorrhea, yawning, and diaphoresis are not seen in nicotine, amphetamine, or marijuana withdrawal.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
12. A patient with a long history of substance abuse is experiencing hallucinations as a result of withdrawal. Which of the following nursing diagnoses would be most appropriate for the manifestations being reported?
1. Thought Processes, Disturbed2. Low Self-Esteem3. Deficient Knowledge4. Risk for Injury
Correct Answer: Thought Processes, Disturbed
Rationale: Disturbed Thought Processes would apply to the patient who is demonstrating an alteration in the perception of reality, as in hallucinations. Low Self-Esteem and Deficient knowledge will likely factor into the plan of care, but do not specifically address the hallucinations being experienced. Risk for Injury might be appropriate; however, the primary issue is the patient experiencing disturbed thought processes with the hallucinations.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
13. A patient is admitted with symptoms of alcohol withdrawal. Which of the following would be of the highest priority for this patient?
1. Support respiratory and cardiac statuses.2. Keep the room dimly lit.3. Encourage verbalization of feelings.4. Encourage taking fluids by mouth.
Correct Answer: Support respiratory and cardiac statuses.
Rationale: Substance abusers who are acutely ill are often treated in the medical–surgical unit of a general hospital. Life-threatening physiological symptoms are addressed first. When the patient is out of danger, the alcoholism addiction issues can be addressed. Although important, keeping the room dimly lit, encouraging verbalization of feelings, and encouraging fluids by mouth should all be attempted after the patient’s cardiac and respiratory statuses are stabilized.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
14. A patient tells the nurse that he plans to stop smoking within the next 6 months. The nurse realizes this patient is in the __________ stage of behavior change.
Rationale: In the contemplation stage of behavior change, the patient intends to change the behavior in the next 6 months. In precontemplation, the patient does not intend to change the behavior in the near future. In preparation, the patient intends to make the change within the next month. In maintenance, the patient works to prevent a relapse to the previous behavior.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
15. A patient tells the nurse that he gets off of the drugs for awhile and then in a few months finds himself “hanging out in the same places” where he knows he can easily get drugs. With which of the following statements should the nurse respond to this patient?
1. “This is drug-seeking behavior and is in response to a craving. What can you do instead of going to the places where you can get drugs?”
2. “This is because you are an addict and need the drugs.”3. “This will happen for the rest of your life. There isn’t anything that you can do to
change it.”4. “Have you considered using a less addictive type of drug instead of the same kind
that you used to use?”
Correct Answer: “This is drug-seeking behavior and is in response to a craving. What can you do instead of going to the places where you can get drugs?”
Rationale: The patient is describing drug-seeking behavior and the nurse should suggest ways for the patient to cope with the behavior by asking the patient what he can do instead of going to the places where he knows he can get drugs. The nurse should not confront the patient and say that he is an addict and needs the drugs. The nurse has no way of knowing if this behavior will continue for the rest of the patient’s life. The patient can learn coping mechanisms to use instead of the drug-seeking behavior. The nurse should not suggest that the patient use a less addictive drug.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
16. A patient tells the nurse that he’s stopped “hanging out with his former friends” and has started going to the gym after work to avoid the temptation of taking drugs. The nurse realizes this patient is achieving which of the following outcomes?
1. Risk reduction with lifestyle changes2. Total and permanent abstinence from drugs3. Live a drug-free life4. Deny the existence of drugs in society
Correct Answer: Risk reduction with lifestyle changes
Rationale: The outcome “risk reduction with lifestyle changes” is demonstrated by this patient’s going to the gym and avoiding his previous friends to reduce the temptation of taking drugs. Although the outcome of “total and permanent abstinence” may be achievable for some patients with some abuse disorders, for others it may be an unattainable goal. Each situation must be assessed individually. Make sure outcomes can be measured so the treatment team is aware of progress and relapse. Living a drug-free life and denying the existence of drugs in society are not realistic and may not be measurable for this patient.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
17. The nurse has determined the outcome criteria for a male patient who has a history of using marijuana to be “impulse control as exhibited by abstinence.” Which of the following would indicate that the patient has achieved this outcome?
1. Patient states that he has not used any marijuana since being in the hospital.2. Patient states that he used marijuana only on the weekends.3. Patient’s mother tells the nurse that she found marijuana in the dresser drawer in
the patient’s room at home.4. Patient’s older brother tells the nurse that he witnessed his brother smoking
marijuana one time since he was hospitalized.
Correct Answer: Patient states that he has not used any marijuana since being in the hospital.
Rationale: Outcome criteria for substance abusers include “impulse control as exhibited by abstinence.” For this outcome to be achieved, the patient must not use any marijuana. The patient stated that he has not used any marijuana, which is evidence of achievement. Using marijuana on the weekends would not be evidence of achievement of the outcome. The mother finding marijuana in the patient’s dresser drawer at home could mean that the patient continues to use marijuana. The patient’s older brother stating that he observed his brother using marijuana would indicate that the outcome was not achieved.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
18. The nurse who is caring for a patient with a history of heroin abuse is assisting the patient to determine ways to avoid the ongoing use of the drug. Which of the following outcomes would best determine that the patient has been successful in not taking heroin?
1. Patient has had no hospital admissions for heroin use and has graduated from the methadone program.
2. The patient was seen in the emergency room one time in the last 6 months for heroin-related symptoms.
3. The patient continues to work and engage in previous social activities.4. Patient has not returned to live with wife and continues to hold part-time
employment.
Correct Answer: Patient has had no hospital admissions for heroin use and has graduated from the methadone program.
Rationale: The best evidence that the patient has been successful in not using heroin would be that the patient has not been admitted to the hospital for heroin use and has graduated from the methadone program. Methadone alleviates the cravings associated with the drug and allows addicts to lead productive lives. Graduation from the methadone program means the patient no longer needs methadone to control cravings. The patient being in the emergency room for heroin-related symptoms would mean that the patient had still been using heroin. Individuals who have substance abuse problems need to change their previous lifestyle, habits, and associations. Patients who continue to work and engage in previous social activities may still access heroin. The patient who has not returned to life with his wife and continues to hold part-time employment may still access heroin.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
19. A patient with heroin addiction has a central line for antibiotic administration to treat an infection. After seeing the patient inject a dose of heroin through the line, the nurse provides sterile syringes and needles for the patient to use in the future. The nurse’s action would be considered:
1. Supportive of the patient’s needs at this time, though not recommended long term.2. Punishable by immediate termination from the health care facility.3. Criminal, and should be reported to the security department and the local police.4. Something that a nurse would never do.
Correct Answer: Supportive of the patient’s needs at this time, though not recommended long term.
Rationale: The nurse realizes the patient is being treated for an infection even though the patient is heroin addict. The nurse is determining what could be done to support the patient’s most pressing need. Because of the current infection, the patient could be making the situation worse by using nonsterile needles and syringes to dose with heroin. Therefore, the nurse made the decision to help reduce the onset of infection by providing sterile needles and syringes. There is not enough information about the situation to suggest the nurse should be punished by immediate termination or be reported to the police for actions taken. This situation would most likely need to be addressed by the organization’s ethics committee.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
20. The nurse, whose husband had been killed by an intoxicated driver, is assigned to provide care to a patient with alcoholism. Which of the following should be done to support this nurse and patient?
1. Discuss with the nurse her ability to plan and provide nonjudgmental care.2. Have the patient transferred to another care area.3. Discharge the patient to home with outpatient treatment scheduled.4. Admit the patient to a 28-day rehabilitation facility.
Correct Answer: Discuss with the nurse her ability to plan and provide nonjudgmental care.
Rationale: The nurse has a personal event that might hinder her ability to provide care to the patient with alcoholism. The nurse should be given an opportunity to discuss her feelings and ability to provide nonjudgmental care to this patient. Moving the patient, discharging the patient, or admitting the patient to a rehabilitation facility might all be unnecessary measures at this time.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
21. A patient with a history of substance abuse is seen for chronic lower back pain. The patient tells the nurse that the only medication that alleviates his pain is Oxycontin, and once he gets the medication, he will leave the clinic. Which of the following should the nurse do?
1. Acknowledge the patient’s dependence on the medication and discuss other pain management approaches.
2. Inform the health care provider that the patient wants Oxycontin and provide with the prescription once it is written.
3. Tell the patient that Oxycontin is an addictive substance and that he will need to find another place to get a prescription.
4. Ask what other substances the patient uses, such as alcohol or marijuana.
Correct Answer: Acknowledge the patient’s dependence on the medication and discuss other pain management approaches.
Rationale: The patient has a history of substance abuse and is currently asking for an opiate to control chronic lower back pain. The nurse should acknowledge the patient’s history of drug dependency and discuss other pain management approaches for the back pain. The nurse should not ask the health care provider for a prescription for Oxycontin and give it to the patient without other interventions. The nurse should not turn the patient away or confront the patient by asking what other substances he uses such as alcohol or marijuana.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.
22. The nurse caring for a patient experiencing alcohol withdrawal had observed the same symptoms in her father in the past. Which of the following actions would indicate that the nurse is providing empathetic care to the patient?
1. Providing antiemetic medication as prescribed and protecting the patient from harm caused by delirium tremens
2. Checking on the patient every 2 hours when necessary3. Keeping the overhead lights and the television on in the room4. Delaying the administration of prescribed Valium
Correct Answer: Providing antiemetic medication as prescribed and protecting the patient from harm caused by delirium tremens
Rationale: The nurse has a personal history of alcohol withdrawal with her father. This could negatively impact this nurse’s ability to provide empathetic care to the patient with the same symptoms. The nurse is providing empathetic care when she provides antiemetic medication as prescribed and protects the patient from harm. Checking on the patient every 2 hours is too infrequent and would not be safe for the patient. Keeping the overhead lights and the television on in the room would be too much stimulation for the patient experiencing alcohol withdrawal symptoms. Delaying the administration of prescribed Valium would also not be evidence of empathetic care by the nurse.
