Substance Use And Withdrawal Care - NCLEX Rn
- Which opioid use disorder medication is a full opioid agonist dispensed in regulated treatment programs?
- Methadone. It stabilizes patients by providing long-acting opioid effects in controlled environments to reduce illicit use.
- Which medication class is first-line for preventing seizures in acute alcohol withdrawal?
- Benzodiazepines. They enhance GABAergic inhibition, reducing neuronal hyperactivity and seizure threshold in withdrawal.
- Which withdrawal syndrome is most likely to cause seizures and delirium tremens?
- Alcohol withdrawal. Abrupt cessation after chronic heavy use leads to central nervous system hyperexcitability, manifesting as seizures and severe delirium.
- Identify the priority concern in benzodiazepine withdrawal: seizures or diarrhea?
- Seizures. Abrupt cessation lowers seizure threshold due to reduced GABA activity, posing a life-threatening risk.
- What is the immediate nursing intervention for acute alcohol withdrawal with agitation and tremors?
- Administer prescribed benzodiazepine. Benzodiazepines calm CNS hyperexcitability, alleviating symptoms like agitation and tremors safely.
- Which assessment finding is most consistent with opioid intoxication rather than withdrawal?
- Miosis with respiratory depression. Opioid receptor activation causes pupillary constriction and central respiratory center suppression.
- Which medication is used for long-term relapse prevention by producing an aversive reaction with alcohol?
- Disulfiram. It blocks aldehyde dehydrogenase, causing acetaldehyde buildup and unpleasant symptoms upon alcohol ingestion.
- Which medication is the opioid antagonist used to reverse opioid overdose?
- Naloxone. It rapidly displaces opioids from mu receptors, reversing central nervous system and respiratory depression.
- Which precaution is highest priority for a patient in severe alcohol withdrawal with confusion?
- Seizure precautions. Severe withdrawal increases seizure risk, necessitating protective measures to prevent injury.
- What timing principle helps prevent precipitated withdrawal when initiating buprenorphine?
- Start when moderate withdrawal is present. Initiating during moderate withdrawal ensures full agonists have sufficiently dissociated from receptors.
- What assessment tool is commonly used to quantify severity of alcohol withdrawal symptoms?
- CIWA-Ar scale. It scores symptoms like nausea, tremor, and anxiety to guide benzodiazepine dosing objectively.
- Which laboratory abnormality is common in chronic alcohol use and increases bleeding risk?
- Thrombocytopenia. Chronic alcohol suppresses bone marrow, leading to reduced platelet production and heightened bleeding tendency.
- Which counseling point is essential for disulfiram therapy regarding alcohol-containing products?
- Avoid all alcohol, including hidden sources. Even small amounts in products like mouthwash can trigger the aversive acetaldehyde reaction.
- Which medication reduces alcohol cravings and blocks opioid receptors to support abstinence?
- Naltrexone. By antagonizing mu receptors, it diminishes the euphoric effects and cravings associated with alcohol.
- Which opioid use disorder medication is a partial opioid agonist that can precipitate withdrawal if started too early?
- Buprenorphine. As a partial agonist, it can displace full agonists from receptors, inducing acute withdrawal symptoms.
- Which medication helps maintain alcohol abstinence by modulating glutamate and GABA balance?
- Acamprosate. It normalizes neurotransmitter imbalances in the brain post-alcohol cessation, reducing relapse likelihood.
- Which infection-prevention action is required after a needlestick from a patient with unknown substance use history?
- Initiate post-exposure protocol per facility policy. Substance use increases risk of bloodborne infections, requiring prompt prophylaxis to prevent transmission.
- What is the most critical adverse effect to monitor after giving naloxone?
- Recurrent respiratory depression. Naloxone's shorter half-life compared to many opioids can lead to re-emergence of overdose symptoms.
- Which vitamin should be given before glucose in chronic alcohol use to prevent Wernicke encephalopathy?
- Thiamine (vitamin B1). Thiamine deficiency in alcoholics can worsen with glucose, precipitating acute neurological damage.
- Which finding suggests stimulant intoxication (cocaine/amphetamines) rather than opioid intoxication?
- Hypertension with tachycardia and mydriasis. Stimulants activate sympathetic nervous system, causing elevated blood pressure, heart rate, and pupillary dilation.
- Which substance withdrawal is most likely to be life-threatening due to seizures: alcohol or opioids?
- Alcohol. Its withdrawal can cause severe seizures and delirium tremens, which are potentially fatal without intervention.
- Which medication is preferred for acute benzodiazepine withdrawal management: taper with benzo or naloxone?
- Taper with a benzodiazepine. Gradual reduction minimizes rebound hyperexcitability and seizure risk associated with sudden discontinuation.
- Which assessment finding is most consistent with opioid withdrawal rather than intoxication?
- Mydriasis with rhinorrhea and diarrhea. Withdrawal triggers sympathetic rebound, leading to dilated pupils and cholinergic symptoms like runny nose and loose stools.
- What is the priority initial nursing action for suspected opioid overdose with respiratory depression?
- Support airway and ventilation. Airway management takes precedence to address life-threatening respiratory depression and maintain oxygenation.