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ADDICTIVE SUBSTANCES PRACTICE QUESTIONS
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ADDICTIVE SUBSTANCES PRACTICE QUESTIONS
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ADDICTIVE SUBSTANCES PRACTICE QUESTIONSA client is being admitted to the hospital following an inadvertent overdose with
oxycodone. He reveals that he has chronic back pain that resulted from an injury on a
construction site. He states, "I know I took too much oxycodone at once, but I can't live
with this pain without them. You can't take them away from me." Which of the following
responses by the nurse is most appropriate?
1."Once you are tapered off the oxycodone, you will find that nonaddictive pain
medicines will be enough to control your pain."
2."You are going to be switched from the oxycodone to methadone for long-term pain
management.
3.The oxycodone will be stopped tomorrow, but you will have lorazepam to help you
with the withdrawal symptoms.
4.Your pain will be controlled by tapering doses of oxycodone, with other pain
management strategies and medicines. - answer- 4
Tapering doses of oxycodone, pain management strategies, and other pain control
medicines are found to be the most helpful with opiate addictions resulting from chronic
pain. Nonaddictive (over-the-counter) medicines alone are generally insufficient for
chronic pain management. Methadone is an addictive opioid that involves substituting
one addiction with another, so now clients are being detoxed off Methadone as well.
Lorazepam may help with anxiety during withdrawal from opiates, but it does not control
the other symptoms of opiate withdrawal.
A school nurse is planning a program for parents on "Drugs Commonly Abused by
Teenagers." Which of the following information should be included about inhalants?
Select all that apply.
1.Monitor for paper bags and rags that may have been used for breathing inhalants.
2.Brain damage is unlikely with the use of inhalants.
3.Use of inhalants by teens is on the decline.
4.Deaths from inhalants occur from asphyxiation, suffocation, and aspiration of vomit.
5.Inhalants usually cause depression of the central nervous system.
6.The basic groups of inhalants are hydrocarbon solvents such as glue, aerosol
propellants from spray cans, and anesthetics/gases. - answer- 1,4,5,6
The nurse should instruct the parents to monitor their children for use of paper bags or
rags. The nurse should present information about brain damage from inhalants
including damage to the frontal lobe, cerebellum, and hippocampus, and that death is
possible. Rather than use being on the decline, teenagers are experimenting even more
with many types of inhalants, such as Freon, ground-up candy disks, and spray
cleaners for computer and TV screens.
The friend of a client brought to the emergency department states, "I guess she had
some bad junk (heroin) today." The client is drowsy and verbally nonresponsive. Which
of the following assessment findings is of immediate concern to the nurse?
,1.Respiratory rate of 9 breaths/min.
2.Urinary retention.
3.Hypotension.
4.Reduced pupil size. - answer- 1
A respiratory rate of less than 12 breaths/min is cause for concern because of central
nervous system depression. Respiratory depression and arrest is the primary cause of
death among clients who abuse opioids. Peripheral nervous system effects associated
with opioid abuse include urinary retention, hypotension, reduced pupil size,
constipation, and decreased gastric, biliary, and pancreatic secretions. Pinpoint pupils
are a sign of opioid overdose. However, respiratory depression is the immediate
concern.
A client is brought to the emergency department by a friend who states, "He was using
a lot of heroin until he ran out of money about 2 days ago." The nurse judges the client
to be in opioid withdrawal if he exhibits which of the following? Select all that apply.
1.Rhinorrhea.
2.Diaphoresis.
3.Piloerection.
4.Synesthesia.
5.Formication. - answer- 1,2,3
Symptoms of opioid withdrawal include yawning, rhinorrhea, sweating, chills,
piloerection (goose bumps), tremors, restlessness, irritability, leg spasms, bone pain,
diarrhea, and vomiting. Symptoms of withdrawal occur within 36 to 72 hours of usage
and subside within a week. Withdrawal from heroin is seldom fatal and usually does not
necessitate medical intervention. Synesthesia (a blending of senses) is associated with
lysergic acid diethylamide use, and formication (feeling of bugs crawling beneath the
skin) is associated with cocaine use.
An unconscious client in the emergency department is given IV naloxone (Narcan) due
to an overdose of heroin. Which of the following would indicate a therapeutic response
to the Narcan? Select all that apply.
1.Decreased pulse rate.
2.Warm skin.
3.Dilated pupils.
4.Increased respirations.
5.Consciousness. - answer- 4,5
Naloxone is an opioid antagonist used to treat an opioid overdose. Within a few
minutes, the client should have an increase of respirations to near normal and become
conscious. With a heroin overdose, the pulse is not significantly affected, the skin
becomes warm and wet, and the pupils are dilated. With naloxone the skin would return
to a normal temperature and become dry. The pupils also would react normally and the
pulse would not be decreased.
, Which of the following should the nurse expect to assess for a client who is exhibiting
late signs of heroin withdrawal?
1.Vomiting and diarrhea.
2.Yawning and diaphoresis.
3.Lacrimation and rhinorrhea.
4.Restlessness and irritability. - answer- 1.
Vomiting and diarrhea are usually late signs of heroin withdrawal, along with muscle
spasm, fever, nausea, repetitive sneezing, abdominal cramps, and backache. Early
signs of heroin withdrawal include yawning, tearing (lacrimation), rhinorrhea, and
sweating. Intermediate signs of heroin withdrawal are flushing, piloerection, tachycardia,
tremor, restlessness, and irritability.
After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor
the client carefully for which of the following?
1.Cerebral edema.
2.Kidney failure.
3.Seizure activity.
4.Respiratory depression - answer- 4
After administering naloxone, the nurse should monitor the client's respiratory status
carefully because the drug is short acting and respiratory depression may recur after its
effects wear off. Cerebral edema, kidney failure, and seizure activity are not directly
related to opioid overdose or naloxone therapy.
When teaching a client who is to receive methadone therapy for opioid addiction, the
nurse should instruct the client that methadone is useful primarily for which of the
following reasons?
1.It is not an addictive substance.
2.A maintenance dose is taken twice a day.
3.The client will no longer be addicted to opioids.
4.The client may work and live normally. - answer- 4
The client takes methadone primarily to be able to work, live normally, and function
productively without the mental and physical deterioration caused by opioid addiction.
Methadone lessens physiologic dependence on opioids and is used to prevent
withdrawal symptoms. Methadone, a substance similar to morphine, is an addictive
substance; the client is still considered addicted to opioids. Because methadone has a
long half-life of 15 to 30 hours, it can be taken once a day on an outpatient basis.
A client states to the nurse, "I'm not going to any more Narcotics Anonymous meetings.
I felt out of place there." Which of the following responses by the nurse is best?
1."Try attending a meeting at a different location; you may feel more comfortable there."
2."Maybe it just wasn't a good day for you. Everybody has bad days now and then."
3."Perhaps you weren't paying close enough attention to what they were saying."
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