Problematic Substance Abuse

Question 1

A patient is experiencing withdrawal from opioids. Which of the following is most commonly associated with acute withdrawal from opioids and opioid-like drugs?

a) Lethargy
b) Constipation
c) Elevated BP
d) decreased BP

Answer 1

c) Elevated BP

Question 2

During treatment for withdrawal from opioids, which agent may be used?

a) Diazepam (Valium)
b) Clonidine (Catapres)
c) Disulfiram (Antabuse)
d) Amphetamine (Dexedrine)

Answer 2

b) Clonidine (Catapres)

Question 3

A patient being admitted from the emergency department is a young female adolescence of unknown age. She is being transferred to the critical care unit after a suicide attempt. The initial assessment shows the following: BP 80/40, pulse 118/min, resp. 8/min; Thought processes are altered, and she is responsive to some verbal commands. Which of the following drugs did the over dose probably involve?

a) Alcohol
b) Marijuana
c) Barbiturates
d) Amphetamines

Answer 3

c) Barbiturates

Question 4

A patient taking disulfiram as part if an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. What symptom may he experience as a result of acetaldehyde syndrome?

a) Lethargy
b) Hypertension
c) Copious vomiting
d) No ill effect because of the small amount of alcohol in the cough syrup

Answer 4

c) Copious vomiting

Question 5

When a patient is assessed for possible substance misuse, which of the following would indicate the possible use of amphetamines?

a) Lethargy and fatigue
b) Cardiovascular depression
c) Talkativeness and euphoria
d) Difficulty swallowing and constipation

Answer 5

c) Talkativeness and euphoria

Question 6

Your patient has been admitted to the labour and delivery department. She has a history of heavy use of alcohol and appears to be intoxicated. What are the potential complications of alcohol use on a fetus, and what would be some concerns during the first few months of the newborn’s life?

Answer 6

1. Heavy use of alcohol by the childbearing or pregnant female has been associated with severe teratogenic effects. This condition is called fetal alcohol syndrome (FAS) and includes craniofacial abnormalities, central nervous system (CNS) dysfunction, and both pre- and postnatal growth retardation in the infant.

Question 7

A friend of yours reveals that she used crack cocaine often in the past few months and tells you that even though she enjoys the sensation she can stop at anytime. What should you do?

Answer 7

2. First of all, this person will not change her behaviour unless she wants to change it. The nurse can try to educate her about the dangers of taking illicit drugs, specifically the cocaine, and how an overdose or “bad” batch could kill her. If the patient wants help, she should seek professional medical care and counselling to assist her with withdrawal and with overcoming psychological dependence. She also needs to realize that this will be a lifelong issue. If necessary, you may need to involve her family in an intervention to help her recognize her problem.

Question 8

A patient is admitted to the hospital for major abdominal surgery, and the physician has ordered that a transdermal nicotine patch be used while the patient is hospitalized because the patient is a heavy smoker until recently. While applying the patch, the patient asks ‘why in the world would you want to give me nicotine when I’m trying to quit smoking?’ How do you answer him?

Answer 8

3. Nicotine withdrawal in hospitalized patients may be manifested by irritability, restlessness, and a decrease in both heart rate and blood pressure. In addition, such patients may experience severe cravings for cigarettes. During the postoperative period, the symptoms of nicotine withdrawal may mask other underlying problems such as hypoxia or even bleeding. The patient will also be more comfortable if the cravings are curbed. The transdermal administration of nicotine provides nicotine without the carcinogens found in tobacco; the patches are part of a stepwise reduction in subcutaneous delivery. Over time, the nicotine dose is gradually decreased.