Substance Abuse & Dependence: Signs, Symptoms, & Treatment PDF

Substance Abuse It affects the CNS resulting in behavioral changes It refers to a pattern of harmful substance use to alter mood Substance abuse leads to significant impairment in functioning It also increases the risk of negative consequences Commonly Abused Substances...

Substance Abuse It affects the CNS resulting in behavioral changes It refers to a pattern of harmful substance use to alter mood Substance abuse leads to significant impairment in functioning It also increases the risk of negative consequences Commonly Abused Substances Alcohol Cannabis Cocaine Opioids Methamphetamine Hallucinogens Inhalants Substance Dependency In tolerance, a person needs an increased amount of the substance to achieve the desired effects. Tolerance causes markedly diminished effects with regular use of the same dose of the substance. Withdrawal causes a specific syndrome of symptoms which develops when a person abruptly stops using the substance. Key Features (DSM-IV Criteria) Tolerance Withdrawal Taking larger amounts or for longer than intended Persistent desire or unsuccessful efforts to cut down Excessive time spent obtaining the substance Giving up important activities due to substance use Continued use despite problems Common Substances Linked to Dependence Alcohol Opioids Benzodiazepines Nicotine Stimulants (e.g., cocaine, methamphetamine) Behavioral and Emotional Signs of Substance Abuse Loss of control over use Irritability or depression when not using Neglecting daily responsibilities  Using alone or in secret Continued use despite awareness of harm DSM-IV vs. DSM-5 DSM-IV: Dependence required 3+ symptoms DSM-5: Substance Use Disorder requires 2-3 symptoms for mild, 4-5 for moderate and 6+ for severe DSM-IV: Separates abuse and dependence DSM-5: Combines abuse and dependence into one diagnosis DSM-IV: Focused on tolerance/withdrawal DSM-5: Broader criteria includes craving, risk-taking Common Health Problems Poor Nutritional Status, loss of appetite, nausea, vomiting, diarrhea CNS Dysfunction: Irritability, Seizure, tremors, sensitivity to light, auditory & visual disturbances, Insomnia Susceptibility to recurrent respiratory infections Liver dysfunction, pancreatitis, hypertension, cirrhosis Chronic brain damage and mental disorientation Poor hygiene, dermatologic changes HIV Positive Volatile Organic Solvents Aromatic Hydrocarbons include toluene, ethylbenzene, and xylene Aromatic Hydrocarbons are found in adhesives, spray paint, thinner, lacquer, leather tanner, disinfectant, cleaner, petroleum, and octane booster Halocarbons include trichloroethylene (TCY), 1,1,1-trichloroethane (TCE), tetrachloroethylene (PERC), and n-Propyl Bromide (nPB) Halocarbons are found in degreasing agent, coffee decaffeination, film cleaner, correction fluid, dry cleaning agent, metal cleaner, and adhesive Aliphatic Hydrocarbons include propane, butane, n-Hexane, and Iso- Octane Aliphatic Hydrocarbons are found in domestic & industrial fuel, lighter fluid, adhesive, and automotive fuel Inhaled Anesthetics Halogenated Ethers include Isoflurane, Halothane, Desflurane, and Sevoflurane, which are general anesthetics Nitrous Oxide is an adjunct anesthetic and aerosol propellant Alkyl Nitrites include Amyl Nitrite, Isobutyl Nitrite, and Isopropyl Nitrite Amyl Nitrite is a vasodilator used in heart disease treatment Isobutyl Nitrite is found in air fresheners and electronics cleaner Isopropyl Nitrite is a cyanide poisoning antidote Dysfunctional Behavior Patterns Manipulation Impulsiveness Dysfunctional Anger Grandiosity Denial Co-dependency Treatment Modalities Detoxification Drug treatment & Rehabilitation Pharmacologic Therapy Psychotherapy Narcotics Anonymous (NA) Founded in California in 1953 NA is Modeled after AA NA focuses on drug addiction for all types of drugs including prescription drugs, heroin, meth, etc. Narcotics Anonymous is present in over 140 countries. The 12 Steps Admit powerlessness over addiction Believe a higher power can help Turn life over to that higher power Make a moral inventory Admit wrongs to self, others, and higher power Be ready to remove character defects Ask for help removing shortcomings Make a list of people harmed Make amends where possible Continue self-inventory Improve connection with higher power Carry the message to others in recovery Alcoholism It is a drinking pattern that interferes with physical, social, familial, vocational, and emotional functioning It is a chronic pattern of pathological alcohol use characterized by impairment in social or occupational functioning along with tolerance or withdrawal symptoms Effects of Alcohol: Sedation General Information on Alcohol  Alcohol is a legal substance and there are millions of social drinkers Classified as CNS Depressant Incidence increasing in adolescent It is considered a disease that can be arrested but not cured Socioeconomic as well as physiologic problem Long term use may result in loss of health Signs and Symptoms of Alcoholism Increased tolerance Frequent blackouts Drinking alone or in secret Neglecting personal, social, or work obligations Mood swings, depression, or anxiety Legal or financial issues Health Consequences of Alcoholism Liver disease (cirrhosis, hepatitis) Heart disease Cancer (mouth, liver, esophagus, breast) Neurological damage Increased risk of accidents, suicide, and violence Assessment of Alcoholism Patterns indicative of alcoholism which include: o Episodic drinking (binges) o Continuous drinking o Morning drinking. o Increase in family fighting about drinking. o Increase in absences from work or school. o Blackouts o Hiding drinking pattern. Legal problems Health problems such as gastritis Family history of alcoholism or substance abuse. Dependent, yet resentful towards authority. Impulsive, abusive behavior. Impaired judgment, memory loss. Incoordination, slurred speech. Mood varies between euphoria and depression. Intoxication Previous experience with treatment centers or Alcoholic Anonymous (AA). Alcohol Withdrawal  It refers to the set of physical and psychological symptoms that occur when a person who is dependent on alcohol suddenly stops or reduces their alcohol intake. Symptoms of alcohol withdrawal include: o Begins shortly after the drinking stops, as soon as 4-6 hours o Anxiety, nausea, insomnia, tremors, hyper alertness, and restlessness o Sudden or gradual increase in all vital signs. Timeline of Alcohol Withdrawal 6-12 hours after last drink: Tremors, anxiety, insomnia, nausea 12-24 hours after last drink: Hallucinations (usually visual) 24-48 hours hours after last drink: Seizures 48-72 hours after last drink: Delirium Tremens (peak risk) Stages of Alcohol Withdrawal Mild Withdrawal (6-12 Hours after last drink) Moderate Withdrawal (12-24 Hours after last drink) Severe Withdrawal (24-72 Hours after last drink) Cognitive Disorders of Alcoholism Alcohol hallucinations Alcohol related dementia which is caused by poor nutrition Korsakoff's syndrome Wernicke's syndrome Korsakoff's Syndrome It is also known as Korsakoff's psychosis and is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B1) often linked to prolonged alcohol abuse. Symptoms of Korsakoff's Syndrome include: Memory Loss Confabulation Disorientation Cognitive and emotional effects of Korsakoff's Syndrome include: Impaired learning Attention problems Executive dysfunction Apathy or emotional flatness Physical Symptoms of Korsakoff's Syndrome: Ataxia and muscle weakness Vision problems Difficulty with speech Treatment for Korsakoff Syndrome: Thiamine Supplementation Intravenous (IV) thiamine and oral thiamine Nutritional Support with Vitamin B1 supplementation Balanced diet Wernicke's Encephalopathy (WE) A neurological disorder that is closely related to Korsakoff's syndrome which is often considered its precursor.  Symptoms of Wernicke's encephalopathy include: Confusion Ataxia Ophthalmoplegia Nystagmus Wernicke-Korsakoff's Syndrome Thiamine Rich Diet which include: Lean pork chops, Salmon Flax seeds Navy beans Green peas Firm tofu Brown rice Squash Asparagus Muscles Treatment of Wernicke-Korsakoff Syndrome Thiamine replacement Nutritional support Alcohol abstinence Cognitive rehabilitation Short term Management: Detoxification related to Alcohol Withdrawal 6-8 hours after drinking: Tremors, Sweating, Agitation 8-12 hours after drinking: Above and hallucinations 2-3 days after drinking: Stage 2 and seizures 2-5 days after drinking: Delirium Tremens Long Term Management: Rehabilitation related to Alcohol Withdrawal Give up Alcohol with Cognitive Behavior Therapy and Marital & Family counselling Live a positive life Support Groups like: o Alcoholic Anonymous for patient o Al-anon for immediate family (Spouse or parent) o Alateen for Teenager or child of the alcoholic patient o Acoa: Adult children of alcoholics Nursing Interventions for Alcohol Withdrawal Stay with the client Monitor VS and blood sugar levels Observe for tremors, seizures, increased agitation, anxiety Provide fluids, adequate nutrition and quiet environment When client is stable provide information about rehabilitation programs Monitor for bleeding if taking oral anticoagulants Group Therapy Number of Participants 8-10 Stage: Forming, Norming, and Storming Formation: Circular Formation Leader: Stable Patient Most Important Element: Motivation Drug Abuse It is a state of dependency where a substance is used repeatedly, involving altered perception and/or mood. Drug Abuse can involve prescription or Street drugs Types of Drugs Commonly Abused Legal Drugs: o Alcohol o Tobacco o Prescription drugs (painkillers, sedatives) Illegal Drugs: o Marijuana o Cocaine o Heroin o Methamphetamine New & Emerging Drugs: o Synthetic drugs (Spice, Bath Salts) o Vaping products Narcotics Purpose: To escape Reality Commonly used Narcotics: o Codeine o Herdin o Oxycodone o Morphine o Meperidine Early Signs of Narcotic Withdrawal Lacrimation Diaphoresis Rhinorrhea Yawning Dryness during withdrawal Late Signs of Narcotic Withdrawal Vomiting Diarrhea Assessment Findings for Drug Abuse/Dependency Determine pattern of drug used. o What drug are used? o What the drug of choice is? o How much is used and how often? o How long has drug/s been used? Physical evidence of drug usage: o Needle track marks o Cellulitis at puncture sites o Poor nutritional status  Possible causes of drug dependency: o Desire to escape reality and problems o Low self-esteem o Peer or cultural pressure o Inherent susceptibility to drug dependence Drug Withdrawal, Overdose and Effects by Drug Type Opiates (Heroin, Morphine, Meperidine, Codaine, Opium, Methadone) Withdrawal: Watery eyes, dilated pupils, Anxiety, Diaphoresis, fever, N/V, and diarrhea, Insomnia, Tachycardia Overdose: Respiratory depression-respiratory arrest, Circulatory depression-cardiac arrest, Unconscious-coma, Death Effect: General physical and mental deterioration, Rapid tolerance, Impaired judgment Cocaine Withdrawal: Depression, Fatigue, Disturbed sleep, Anxiety, Psychomotor agitation Overdose: Tachycardia, Pupillary dilatation, Increased BP, Cardiac arrhythmias, Perspiration, chills, N/V Effect: Psychomotor dependence, Tolerance within hours or days Amphetamines Withdrawal: Depression, Fatigue, Disturbed Sleep Overdose: Restlessness, Tremors, Rapid Respiration, Confusion, Assaultive behavior, Panic Effect: Paranoid Delusion Hallucinogens Withdrawal: None Overdose: Panic, Psychosis Effect: Flashbacks, Impaired judgement Benzodiazepines(Valium, Serax, Ativan) Withdrawal: Tremors, Agitation, Anxiety, Abdominal Cramps, Grandmal Seizures Overdose: Drowsiness, Confusion, Hypotension, Coma Effect: Withdrawal occurs if abrupt cessation, Temporary psychosis Cause of Drug Abuse Peer Pressure  Mental health issues(e.g. depression,anxiety) Family problems or Trauma Curiosity or Thrill Seeking Lack of Education or Awareness Drug-Disease Interactions Asthma: Avoid Beta Blockers as they can cause bronchospasm Chronic Liver Disease: Avoid Warfarin which can cause increase sensitivity and bleeding CHF: Avoid Calcium Channel Blockers and NSAIDs as this can cause Sodium Retention, increase risk of cardiac events Epilepsy: Avoid Steroids (Prednisone) as this causes Sodium & Water Retention HPN: Avoid TCA's, Antimalarial, Antipsychotics as this Reduced Seizure Thresholds Parkinson's Disease: Avoid NSAIDs as this causes Increase BP due to Sodium Retention Renal Failure: Avoid COX-2 Inhibitors as this can cause Worsening of the disease Respiratory Failure: Avoid NSAIDs as this causes Nephrotoxicity Avoid Neuroleptics as this causes Respiratory Depression Antidotes by Drug Type Opioids - Naloxone (Narcan) Warfarin - Vitamin K Heparin - Protamine Sulfate Digoxin - Digifab/Digi bind Anticholinergics - Physostigmine Benzodiazepine - Flumazenil Cholinergic Crisis - Atropine Acetaminophen - Acetylcysteine Magnesium Sulfate - Calcium Gluconate Lead - Succimer or Calcium Disodium Edetate Alcohol Withdrawal - Chlordiazepoxide Beta Blockers - Glucagon Aspirin - Sodium Bicarbonate Calcium Channel Blockers - Glucagon, Insulin, Calcium Nursing Interventions for Drug Abuse Assess level of consciousness and vital signs. Monitor intake & output and electrolytes. Implement suicide precautions if assessment indicates risk of self-harm. Provide adequate nutrition, hydration, and rest. Focus on substance abuse problem. Confront placing blame on external problems. Reinforce reality with simple, concrete terms  Encourage verbal expression of anger and depression. Assist with identification of stressors and areas of conflict. Positively reinforce insight into behavior patterns. Help identify an appropriate support system. Provide support to significant others. Provide adequate nutrition, hydration, and rest. Administer medications according to detoxification protocol of medical unit. Teach danger of AIDS and blood-related diseases. Provide adequate nutrition, hydration, and rest. Serious Effects of Drug Addiction Impact on Children: 1 in 5 children grow up with a parent who abuses drugs or alcohol, and abused children have a higher chance of addiction later in life Loss of Trust: Addicts aren't likely to follow through on their word even if they mean to initially, which causes strain in their relationships Increased Stress: Those who live with an addict tend to take on stress due to their partner neglecting them and their responsibilities Financial Problems: Whether it's financing drugs & alcohol, or losing a job due to substance abuse, addiction causes massive financial strain Physical & Emotional Abuse: Those who abuse substances are likely to act out against their loved ones, abusing them in the process Fear & Confusion: Drug abuse typically makes a person's actions unpredictable, so to avoid conflict, loved ones may walk on eggshells out of fear. Co-Dependency It is a set of maladaptive behaviors exhibited by the loved ones of those with substance use disorders. Codependent behaviors allow an individual to maintain control by fulfilling the needs of the person with a substance use disorder. Behaviors include concealing the severity of the substance use, receiving physical or psychological abuse from the client, withholding the client to experience the consequences of their actions, and making excuses for the client's habit. Codependent individuals focus all their attention on others at the expense of their own sense of self. Codependent spouses, friends, and family members can keep the client from focusing on treatment; this behavior is counterproductive to both themselves and the client. Codependency can look different in each family dynamic, but it is almost always coupled with enabling the client and failure to recognize that the client has a problem. 231. A client with a history of opioid use disorder is being admitted for detoxification. The nurse recognizes that which of the following symptoms indicates the need for immediate medical intervention? A) Dilated pupils and sweating B) Nausea, vomiting, and diarrhea C) Increased pulse rate and blood pressure D) Loss of appetite and tremors 232. A client is receiving treatment for substance use disorder and is attending group therapy. The nurse understands that the purpose of group therapy in addiction treatment is primarily to: A) Provide a space for the client to vent anger in a safe environment B) Allow the therapist to observe interactions and control group dynamics C) Promote socialization and provide emotional support from others in recovery D) Offer individual counseling during a group setting 233. A client in detoxification for opioid use disorder is experiencing symptoms of withdrawal. Which of the following medications should the nurse expect to be prescribed to manage these withdrawal symptoms? A) Naloxone B) Methadone C) Disulfiram D) Naltrexone 234. A nurse is discussing the role of Narcotics Anonymous (NA) in the recovery of individuals with opioid use disorder. Which of the following statements made by the client indicates a correct understanding of the purpose of NA? A) "NA will give me all the answers to stop using opioids permanently." B) "In NA, I will meet people who understand what I am going through and can offer support." C) "The primary focus of NA is to take medications to help me quit opioids." D) "I can stop attending NA meetings once I have been sober for 6 months." 235. A nurse is teaching a client about Narcotics Anonymous (NA) as part of a comprehensive treatment plan for opioid use disorder. Which of the following statements by the client indicates a need for further teaching? A) "I understand that NA is a group program that can support me in staying sober." B) "NA helps me learn strategies for managing cravings and stress." C) "NA will help me control my opioid use by teaching me how to use them in moderation." D) "I can share my experiences with others who have struggled with opioid addiction." 236. A nurse is caring for a client with substance dependency. Which of the following is the most Likely physical sign of opioid dependency? A) Dilated pupils and increased body temperature B) Pinpoint pupils and slurred speech C) Dry mouth and elevated heart rate D) Diarrhea and excessive sweating 237. A client with substance dependency is prescribed methadone as part of their treatment. The nurse should educate the client that methadone is used to: A) Induce rapid detoxification from opioids B) Treat opioid dependence by reducing cravings and withdrawal symptoms C) Substitute for alcohol use in individuals with alcohol dependency D) Prevent the effects of opioid overdose in the event of relapse 238. A nurse is caring for a client admitted for alcohol withdrawal. The nurse knows that which of the following is the most important initial intervention? A) Administer a benzodiazepine as ordered B) Offer the client water and fluids frequently C) Encourage the client to engage in group therapy D) Monitor the client's vital signs every 4 hours 239. A nurse is providing education to a group of clients in a rehabilitation facility about the effects of alcohol on the body. Which of the following statements should the nurse identify as correct? A) "Alcohol is a stimulant and can increase energy levels." B) "Alcohol increases the risk of liver damage, especially with chronic use." C) "Drinking alcohol can reduce the risk of heart disease." D) "Alcohol helps the body absorb vitamins and nutrients more effectively." 240. A nurse is teaching a client about disulfiram (Antabuse) for the treatment of alcohol use disorder. Which of the following statements by the client indicates the need for further teaching? A) "If I drink alcohol while taking this medication, I will feel very sick." B) "I should avoid alcohol-containing products, like cough syrup, while on this medication." C) "I can still drink a little bit of alcohol in social situations, as long as I don't overdo it." D) "I will need to take this medication every day as part of my treatment plan." 241. A nurse is assessing a client admitted with substance use disorder. The nurse should assess for which of the following physical signs of alcohol withdrawal? A) Hypotension and bradycardia B) Dilated pupils and increased body temperature C) Pale skin and cold extremities D) Weight gain and elevated blood pressure 242. A client is attending their first Alcoholics Anonymous (AA) meeting. The nurse explains that one of the key components of the 12-Step program is: A) Attending therapy sessions with a licensed professional. B) Finding a sponsor to guide them through the recovery process. C) Using medications to reduce alcohol cravings. D) Learning to control alcohol consumption in social situations. 243. A nurse is explaining to a client that Alcoholics Anonymous (AA) meetings are based on the principle of peer support. Which of the following statements made by the client indicates a correct understanding of AA meetings? A) "I can attend AA meetings, but I won't need to talk about my addiction if I don't want to." B) "In AA, I will receive therapy and counseling from professionals." C) "AA meetings are for individuals who want to drink in moderation." D) "I am required to share my experiences at every meeting to get support." 244. A nurse is educating a client about the principles of Alcoholics Anonymous (AA). Which of the following should the nurse include in the education regarding the role of a sponsor? A) "The sponsor will provide therapy and prescribe medication to help manage cravings." B) "The sponsor will guide you through the 12-Step program and offer support in recovery." C) "The sponsor will focus on your family dynamics and help you repair relationships." D) "The sponsor will give you direct orders on how to stop drinking." 245. A nurse is caring for a client who has been diagnosed with Korsakoff syndrome. Which of the following symptoms is most characteristic of this disorder? A) Impaired coordination and eye movement B) Severe memory impairment, particularly short-term memory C) Acute confusion and disorientation D) Sudden onset of speech deficits 246. A client with a history of chronic alcohol abuse is diagnosed with Korsakoff syndrome. The nurse understands that the most likely cause of this disorder is: A) A vitamin C deficiency B) An iron deficiency anemia C) A thiamine deficiency D) A folate deficiency 247. A nurse is educating a client diagnosed with Korsakoff syndrome. Which of the following is an essential aspect of treatment for this condition? A) Administering thiamine supplementation B) Encouraging participation in high-intensity physical activities C) Teaching cognitive behavioral therapy to manage symptoms D) Initiating antipsychotic medications to manage confusion 248. A nurse is assessing a client with suspected Wernicke's encephalopathy. Which of the following symptoms is most commonly associated with this condition? A) Sudden loss of vision B) Nystagmus and ophthalmoplegia C) Tremors and rigidity D) Slurred speech and dysphagia 249. A nurse is caring for a client with a history of chronic alcohol abuse. The client is diagnosed with Wernicke's encephalopathy. Which of the following pathophysiological changes occurs in the brain due to thiamine deficiency? A) Damage to the basal ganglia B) Atrophy of the cerebellum C) Injury to the hypothalamus and thalamus D) Enlargement of the ventricles 250. A nurse is caring for a client diagnosed with Wernicke's encephalopathy. The nurse understands that the priority intervention is: A) Administering intravenous thiamine B) Administering oral thiamine supplements C) Providing a high-protein diet to prevent muscle wasting D) Offering fluid restrictions to prevent overload 251. Jeremy is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. A. Heroin B. Cocaine C. LSD D. Marijuana 252. Ramon is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but that he can control his use if he chooses. Which coping mechanism is he using? A. Withdrawal B. Logical thinking C. Repression D. Denial 253. The clinic nurse speaks with the spouse of a client being treated for alcohol use disorder. Which statements by the spouse indicate codependence? Select all that apply 1. I cannot imagine anyone caring for my spouse 2. I joined a new book club and I really enjoyed my new friends 3. I try to keeping my children from being too loud so my spouse can sleep in on the weekdays 4. My spouse is typically a social drinker. I don't see the problem with drinking a little more than usual 5. When my spouse doesn't come home until late in the evening, I encourage my spouse to call in sick and rest 254. The spouse of the client who is currently in inpatient treatment for substance abuse tells the nurse, "We've done this so many times. I don't think my spouse is ever going to change. Do you think it's time for me to get a divorce?" Which response by the nurse is most helpful? a. "You don't think your spouse is ever going to change?" b. "Sounds like you're frustrated with how things are going on with you and your husband." c. "Your spouse will likely continue to use and need treatment again." d. "That's your decision; I can't tell you whether you should get a divorce." 255. The LEAST effective education and preventive measure for drug abuse is: A. Activity workshops for out of school youths B. Family enrichment programs C. Regular advocacy meetings to include families, store, restaurant, bar owners D. Leaflets and brochures for mass distribution 256. A patient discharged from an alcohol rehabilitation program was on Clonazepam (Klonopin) 0.5 mg. three times a day. Several months later he reported having insomnia, shakiness, sweating, and one seizure. Which of the following questions should you ask FIRST? Ask if he a. has stopped taking the Klonopin suddenly b. has been drinking alcohol with the Klonopin c. has developed tolerance to the Klonopin and needs to increase the dose. d. is having a panic attack and needs to take extra Klonopin. 257. One of your patients is manifesting signs and symptoms of alcohol withdrawal such as: tremors, diaphoresis, and hyperactivity, Blood pressure is 190/92 mmHg and pulse rate of 92 beats/min. Which of the following medications should you expect to be ordered for this patient? a. Lorazepam (Ativan) b. Naloxone (Narcan) c. Haloperidol (Haldol) d. Benztropine(Cogentin) 258. Nurse Amy is providing care for a male client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with A. Barbiturates B. Amphetamines C. Methadone D. Benzodiazepines 259. Dervid, an adolescent boy was adrnitted for substance abuse and hallucinations. The client's mother asks Nurse Armando to talk with his hustrand when he arrives at the hospital. The mother says that she is afraid of what the father might say to the boy. The most appropriate nursing intervention would be to: A. Inform the mother that she and the father can work through this problem themselves. B. Refer the mother to the hospital social worker. C. Agree to talk with the mother and the father together. D. Suggest that the father and son work things out. 260. What is Nurse John likely to note in a male client being admitted for alcohol withdrawal? A. Perceptual disorders. B. Impending Coma. C. Recent alcohol intake. D. mutism. Depression with 261. Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals? A. Alcohol withdrawal B. Cannabis withdrawal C. Cocaine withdrawal D. Opioid withdrawal 262. A nurse is assessing a client suspected of having Wernicke's encephalopathy. Which of the following findings would the nurse expect to observe upon assessment? A) Bilateral hand tremors and muscle rigidity B) Sudden loss of hearing and speech difficulties C) Ataxia, confusion, and nystagmus D) Increased blood pressure and tachycardia 263. A client diagnosed with Wernicke's encephalopathy is not responding to thiamine treatment. The nurse is concerned that the client may progress to which of the following conditions? A) Parkinson's disease B) Korsakoff syndrome C) Alzheimer's disease D) Multiple sclerosis 264. A nurse is assessing a client who is attending Alcoholics Anonymous (AA) meetings. The nurse understands that which of the following is the most beneficial aspect of participating in AA meetings? A) Receiving prescribed medications to reduce alcohol cravings B) Engaging in therapy and psychotherapy through group discussions C) Building a support network with others who have experienced similar struggles D) Learning to consume alcohol in moderation to reduce harm 265. A nurse is working with a client who has just started attending Alcoholics Anonymous (AA). The nurse knows that the primary goal of the 12-Step program is to: A) Help individuals gain control over alcohol consumption. B) Provide medical treatment for alcohol withdrawal symptoms. C) Achieve complete abstinence from alcohol and sustain long-term recovery. D) Focus on self-discipline to prevent future alcohol use. 266. A nurse is assessing a client with substance dependency. The client reports using alcohol daily in the evening to relax. Which of the following statements by the client indicates physical dependence on alcohol? A) "I drink because it helps me forget about my stressful day." B) "I sometimes drink to help me sleep." C) "I have a drink every evening, but I feel fine in the morning." D) "I feel nervous and shaky if I don't have a drink in the evening." 267. A nurse is educating a client about the signs and symptoms of alcohol withdrawal. Which of the following symptoms would the nurse expect to observe in the early stages of alcohol withdrawal? A) Seizures and delirium tremens B) Increased heart rate and tremors C) Dehydration and hypotension D) Hallucinations and agitation 268. A nurse is caring for a client with chronic alcoholism. The nurse suspects the client may be experiencing alcoholic liver disease. Which of the following findings would be most concerning for the nurse? A) A positive Alcohol Use Disorder screening and a history of binge drinking B) Jaundice, ascites, and an elevated liver enzyme level C) A recent history of alcohol consumption and normal laboratory findings D) A history of alcohol use with occasional binge drinking episodes 269. A nurse is educating a client with alcohol use disorder about the potential complications of alcohol abuse. Which of the following should the nurse explain as a potential consequence of long-term alcohol consumption? A) Increased bone density and muscle strength B) Damage to the gastrointestinal tract and liver C) Improved memory and cognitive function D) Decreased blood pressure and reduced heart rate 270. A nurse is assessing a client with alcohol use disorder. Which of the following is the most appropriate initial assessment for this client? A) Assessing the client's ability to stop drinking for 24 hours. B) Asking the client to identify triggers for alcohol consumption. C) Performing a physical exam to check for signs of alcohol withdrawal. D) Asking the client about the number of alcoholic beverages consumed per day. 271. A nurse is caring for a client with a history of chronic alcoholism who is at risk for delirium tremens (DTs). Which of the following interventions should the nurse prioritize to prevent complications from this condition? A) Monitoring vital signs frequently and providing a quiet, low-stimulation environment. B) Encouraging the client to walk and engage in physical activities to reduce agitation. C) Providing a high-fat diet to support liver function during detoxification. D) Encouraging the client to attend support groups like Alcoholics Anonymous (AA) immediately. 272. A nurse is caring for a client with alcohol use disorder who is experiencing alcohol withdrawal. Which of the following symptoms would indicate delirium tremens (DTs) in this client? A) Diarrhea and vomiting. B) Severe confusion, hallucinations, and increased blood pressure. C) Slurred speech and impaired motor coordination. D) Tremors and mild anxiety. 273. A nurse is caring for a client in alcohol withdrawal. The nurse observes that the client is becoming increasingly agitated, is having difficulty focusing, and is showing signs of hallucinations. The nurse should: A) Wait for the symptoms to resolve on their own, as they are common in alcohol withdrawal. B) Immediately administer a dose of lorazepam to prevent complications of withdrawal. C) Provide the client with an oral rehydration solution and encourage rest. D) Offer the client an antipsychotic medication to address the hallucinations. 274. Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see: A. Tension and irritability B. Slow pulse C. Hypotension D. Constipation 275. You are a Drug Abuse Treatment and Rehabilitation Center Nurse. During the assessment of a newly admitted Person Who Uses Drugs (PWUDs) named Korino, which of the following is the MOST APPROPRIATE question to ask? A. Ask Korino how long he thought that he could take drugs without someone finding it. B. Ask Korino why he started taking illegal drugs. - DON'T ask why C. Not ask any questions for fear Korino will deny and may become assaultive D. Ask Korino about the amount of drug used and its effect and how long he had been using 276. Upon data collection he had been failing three times in his math class and Korino was known for substance dependence for three years. What is the MOST APPROPRIATE nursing diagnosis for him? A. Alteration in perception B. Alteration in social interaction C. Ineffective individual coping D. Impaired judgment 277. Korino has been using meperidine and codeine for personal consumption. Which of the following does the nurse understand as the physiologic effect of these drugs? A. Increases sexual stimulation B. Relieves pain by increasing pain threshold C. Decrease craving for alcoholic intake D. Heightens concentration and alertness 278. What drug should the nurse prepare for administration to reverse all signs of toxicity? A. Digibind (Digoxin) B. B. Naloxone (Narcan) C. Atropine Sulfate D. Diazepam (Valium