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The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.)
- A. Agitation
- B. Drowsiness
- C. Tremors
- D. Systolic blood pressure higher than 160 mm Hg
- E. Temperature over 100?°F
- F. Pulse over 100 beats/min
Correct Answer: A,C,D,F
Rationale: Severe ethanol withdrawal (delirium tremens) is characterized by agitation, tremors, systolic blood pressure over 160 mm Hg, and pulse over 100 beats/min. Drowsiness is not typical, and while fever may occur, a specific threshold like 100?°F is not universally diagnostic.
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A patient has been taking disulfiram as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.)
- A. Euphoria
- B. Severe vomiting
- C. Diarrhea
- D. Pulsating headache
- E. Difficulty breathing
- F. Sweating
Correct Answer: B,D,E,F
Rationale: Acetaldehyde syndrome, triggered by alcohol consumption while on disulfiram, causes severe vomiting, pulsating headache, difficulty breathing, and sweating due to acetaldehyde buildup. Euphoria and diarrhea are not associated with this syndrome.
A nurse is providing teaching for a patient who will be taking varenicline as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.)
- A. This drug is available as a chewing gum that can be taken to reduce cravings.
- B. Use caution when driving because drowsiness may be a problem.
- C. There have been very few adverse effects reported for this drug.
- D. Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.
- E. Avoid caffeine while on this drug.
Correct Answer: B,D
Rationale: Varenicline, an oral tablet, can cause drowsiness, requiring caution during activities like driving, and is associated with psychiatric risks like depression or suicidality, necessitating immediate reporting. It is not a gum, has common side effects like nausea and insomnia, and has no specific caffeine restrictions.
A patient has been taking naltrexone as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient?
- A. Naltrexone prevents the cravings for opioid drugs.
- B. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal.
- C. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone.
- D. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid's desired effects are lost.
Correct Answer: D
Rationale: Naltrexone blocks opioid receptors, preventing the euphoria associated with heroin use, thus reducing the reinforcing effects of the drug. It does not directly prevent cravings, act as a substitute, or cause severe nausea like disulfiram does with alcohol.
A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram therapy?
- A. He should not smoke cigarettes while on this drug.
- B. He needs to know about the common over-the-counter substances that contain alcohol.
- C. This drug will cause the same effects as the alcohol did, without the euphoric effects.
- D. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.
Correct Answer: B
Rationale: Disulfiram causes severe adverse reactions when combined with alcohol, including from over-the-counter products like mouthwashes or cough medicines, as even small amounts (e.g., 7 mL) can trigger symptoms. Smoking is not contraindicated, and disulfiram does not mimic alcohol's effects.
When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition?
- A. Renal failure
- B. Cerebrovascular accident
- C. Korsakoff's psychosis
- D. Alzheimer's disease
Correct Answer: C
Rationale: Chronic alcohol use is associated with Korsakoff's psychosis, a neurologic disorder caused by thiamine deficiency, often linked to alcoholism. Renal failure, cerebrovascular accidents, and Alzheimer's disease are not directly caused by chronic alcohol use.