Nursing Chapter 23 Flashcards

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Questions and Answers

How long may the sensitivity to alcohol last after discontinuing Antabuse?

2 weeks

Which is the priority nursing intervention for a client admitted for acute alcohol intoxication?

Teach the negative effects of alcohol on the body.

Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system.

Assess aggressive behaviors in order to intervene to prevent injury to self or others. (correct)

Darken the room to reduce stimuli in order to prevent seizures.

How should the nurse interpret a client's statement, 'My life is unmanageable,' in a 12-step program?

The client is ready to sign an Alcoholics Anonymous contract for sobriety.

The client is using minimization as an ego defense.

The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. (correct)

The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

Withdrawal from which substance may require a life-saving emergency intervention?

Diazepam (Valium) Signup and view all the answers

How should the nurse evaluate the possibility of a drinking problem in a client being admitted for surgery?

By using a screening tool such as the CAGE questionnaire. Signup and view all the answers

Which nursing statements exemplify important insights for effective intervention with clients diagnosed with substance use disorders? (Select all that apply)

Because of my father's alcoholism, I need to examine my attitude toward these clients. Signup and view all the answers

Which statement about complications of hepatic encephalopathy indicates the need for further teaching?

In this condition, blood accumulates in the abdominal cavity. Signup and view all the answers

What is a common symptom associated with delirium in older adults?

Taking multiple medications may lead to adverse interactions or toxicity. Signup and view all the answers

Which information should cause the nurse to question a vascular dementia client's safety at home?

The client smokes one pack of cigarettes per day. Signup and view all the answers

What stage of Alzheimer's disease is characterized by the inability to ambulate and agitation?

Late stage Signup and view all the answers

Which intervention should take priority for a client in the late stage of Alzheimer's disease?

Promote dignity by providing comfort, safety, and self-care measures. Signup and view all the answers

A nurse should recognize classic signs of which condition in a client with memory changes?

Neurocognitive disorder Signup and view all the answers

What does donepezil (Aricept) do in treating Alzheimer's disease?

Delays the destruction of acetylcholine. Signup and view all the answers

Which symptom differentiates neurocognitive disorders from pseudodementia?

Impaired attention and concentration Signup and view all the answers

When should a nurse expect clients with Alzheimer's disease to exhibit more pronounced symptoms?

At twilight Signup and view all the answers

Which nursing intervention is most appropriate for a client diagnosed with a neurocognitive disorder?

Schedule structured daily routines. Signup and view all the answers

What should cause the nurse to question a diagnosis of major neurocognitive disorder?

Neurocognitive disorder does not develop suddenly. Signup and view all the answers

Which nursing intervention should take priority for a client diagnosed with neurocognitive disorder?

Assist with bathing and toileting. Signup and view all the answers

What initial action should a nurse implement for a client exhibiting escalating behavioral problems?

Assess environmental triggers and potential unmet needs. Signup and view all the answers

What diagnosis is expected for a client with a history of cerebrovascular accident and memory problems?

Vascular neurocognitive disorder Signup and view all the answers

Which medication is likely to be prescribed for an older client experiencing social isolation?

Sertraline (Zoloft) Signup and view all the answers

What is the priority nursing diagnosis for a client who is disoriented and wanders?

Risk for injury Signup and view all the answers

Which symptom differentiates neurocognitive disorders from amnesic disorders?

Neurocognitive disorders involve impairment of abstract thinking and judgment, whereas amnestic disorders do not. Signup and view all the answers

What is the main topic covered in Chapter 23?

Substance-Related and Addictive Disorders Signup and view all the answers

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?

Risk for injury R/T central nervous system stimulation Signup and view all the answers

Why should a nurse assess a client with 100 PCA attempts in 30 minutes for substance use disorder?

Clients using alcohol or benzodiazepines may have developed cross-tolerance to analgesics requiring increased doses. Signup and view all the answers

On the first day of a client's alcohol detoxification, which intervention should take priority?

Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Signup and view all the answers

Which client statement indicates a knowledge deficit related to substance use?

Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless. Signup and view all the answers

What term should a nurse use to best describe a lonely, depressed divorcee self-medicating with cocaine?

Psychological addiction Signup and view all the answers

Which term describes the administration of a CNS depressant during alcohol withdrawal?

Substitution therapy Signup and view all the answers

Which client outcome related to Alcoholics Anonymous (AA) is most appropriate for a nurse to discuss during discharge?

After discharge, the client will immediately attend 90 AA meetings in 90 days. Signup and view all the answers

Which symptom should the nurse immediately report to the ED physician for a client with heavy alcohol use recently abstaining?

Blood pressure of 180/100 mm Hg Signup and view all the answers

Which client statement demonstrates positive progress toward recovery from a substance use disorder?

Taking those pills got out of control. It cost me my job, marriage, and children. Signup and view all the answers

Why does the nurse hold the hand of a client withdrawing from alcohol?

To assess for fine tremors Signup and view all the answers

What should be the priority nursing diagnosis for a client with alcohol withdrawal symptoms and not eating for 3 days?

Imbalanced nutrition: less than body requirements Signup and view all the answers

Which client statement indicates a positive prognosis for a mother with a history of chronic heroin use?

I cannot control my use of heroin. It's stronger than I am. Signup and view all the answers

What should a nurse say to a wife who makes excuses for her alcoholic husband's work absences?

Your husband needs to deal with the consequences of his drinking. Signup and view all the answers

What medication orders should a nurse anticipate for a client with complicated withdrawal from benzodiazepines?

Chlordiazepoxide (Librium) and phenytoin (Dilantin) Signup and view all the answers

How should a nurse interpret a client's statement involving blame towards their spouse during therapy?

The client is using rationalization to excuse his alcohol dependence. Signup and view all the answers

What initial outcome should a nurse expect from a client undergoing outpatient drug treatment?

The client will correlate life problems with alcohol use. Signup and view all the answers

At what minimum blood alcohol level should a nurse expect intoxication to occur?

100 mg/dL Signup and view all the answers

When should a nurse expect withdrawal symptoms in a client with a history of daily bourbon drinking who has abstained for 1 hour?

Between 3 a.m. and 11 a.m. Signup and view all the answers

Why should a nurse encourage a client with depression and substance use disorder to first try nonpharmacological interventions?

Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. Signup and view all the answers

What nursing diagnosis should be documented for a client taking chlordiazepoxide that no longer helps with sleep?

Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep Signup and view all the answers

What symptoms should the nurse expect to assess during alcohol detoxification?

Gross tremors, delirium, hyperactivity, and hypertension Signup and view all the answers

What may indicate to the ED nurse that a recovering alcoholic has experienced a reaction to disulfiram (Antabuse)?

A reaction to disulfiram (Antabuse) Signup and view all the answers

What should the nurse reply to a client questioning about acamprosate calcium (Campral)?

This medication will help you maintain your abstinence. Signup and view all the answers

What should a nurse include when teaching a client about disulfiram (Antabuse)?

Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug. Signup and view all the answers

Study Notes

Alcohol withdrawal can lead to symptoms such as tremors, seizures, nausea, tachycardia, and hallucinations.
Risk for injury is the priority nursing diagnosis during alcohol withdrawal due to CNS stimulation.

Nursing Interventions and Assessments

Administer benzodiazepines like chlordiazepoxide (Librium) during detoxification to manage withdrawal symptoms effectively.
Assess clients with high PCA pump attempts for potential substance use disorder, particularly cross-tolerance to analgesics.

Knowledge and Education on Substance Abuse

It's important to educate clients about the dangers of comparing substances like marijuana to cigarettes, as both have harmful effects.
Clients should acknowledge the full scope of their addiction to enhance recovery potential.

Recovery Support

Alcoholics Anonymous (AA) encourages attendance of 90 meetings in 90 days for newly recovering individuals as a crucial support measure.
Clients should recognize their powerlessness over alcohol, marking a pivotal step in their recovery journey.

Withdrawal Symptoms

Common symptoms of alcohol withdrawal include gross tremors, delirium, and hypertension, requiring vigilant monitoring.
Expect withdrawal symptoms to appear 4 to 12 hours after cessation of heavy drinking.

Intoxication and Medications

A blood alcohol level of 100 mg/dL is considered the minimum for intoxication, with severe outcomes reported at much higher levels.
Non-pharmacological interventions should be prioritized before prescribing sedative-hypnotics due to their addictive potential.

Psychological and Emotional Aspects

Psychological addiction reflects a client's overwhelming desire to use a substance to avoid discomfort or achieve pleasure.
Rationalization is a common defense mechanism used by clients to avoid taking responsibility for their substance use behaviors.

Community and Family Involvement

Involving family in recovery processes, such as understanding enabling behaviors, is essential for supporting clients in overcoming addiction.
Education on medications like disulfiram (Antabuse) emphasizes that alcohol sensitivity may last up to two weeks after stopping the medication.

Conclusion of Thoughts on Substance Use

Acknowledging life becoming unmanageable is a step towards recovery and indicates progress in recognizing addiction challenges.
The withdrawal from benzodiazepines can necessitate emergency interventions due to the risk of severe complications like increased CNS excitability.### Alcohol Use and Screening
The CAGE questionnaire screens for alcohol problems, consisting of four simple questions.
Scoring two or three "yes" answers indicates a strong likelihood of an alcohol issue.

Substance Use Disorder Insights

Nurses must examine personal biases and negative attitudes toward clients with substance use disorders.
Recognize that substance use disorders can affect individuals from various backgrounds without assumptions about education or refinement.

Hepatic Encephalopathy Understanding

Diets high in protein can worsen hepatic encephalopathy; clients may require a temporary elimination of protein.
The condition is characterized by increased serum ammonia, leading to impaired mental function.
Neomycin and lactulose are commonly used treatments.

Delirium Risk Factors

Taking multiple medications can lead to adverse interactions, increasing the risk of delirium in older adults.
Cognitive changes related to aging may also contribute to altered mental status.

Vascular Dementia Safety

Smoking one pack of cigarettes daily raises concerns regarding the safety of clients with vascular dementia.
Evaluating family support and living conditions is essential for safety assessments.

Alzheimer's Disease Stages

The late stage of Alzheimer's presents with severe cognitive decline, loss of ambulation, and agitation.
Promoting dignity through comfort and self-care is a key nursing intervention in advanced stages.

Neurocognitive Disorder (NCD) Characteristics

Classic signs include progressive memory loss, poor judgment, and short attention span.
Attention and concentration remain intact in depression (pseudodementia) but are impaired in NCD.

Sundowning Phenomenon

Clients with Alzheimer's exhibit worsened symptoms at twilight, known as "sundowning."

Behavioral Management in NCD

Structured daily routines can reduce frustration and aggressive behaviors in clients with neurocognitive disorders.

Diagnostic Considerations for Memory Issues

Neurocognitive disorders typically do not have a sudden onset, distinguishing them from other potential diagnoses.
Secondary symptoms that suggest injury risk should be prioritized in client assessments.

Medication for Older Adults

SSRIs like sertraline (Zoloft) are commonly prescribed for older adults facing depression, which can mimic neurocognitive disorder symptoms.

Differentiating Disorders

Neurocognitive disorders involve impairment in abstract thinking and judgment, unlike amnesic disorders which primarily affect memory and recall without other cognitive impairments.

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Description

Test your knowledge with flashcards focused on Chapter 23: Substance-Related and Addictive Disorders. This quiz includes essential nursing diagnoses and approaches for clients experiencing alcohol withdrawal. Enhance your understanding of critical concepts in nursing care for substance-related issues.