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Nursing Field Notes / Pharmacology · Mental Health “Psychiatric Care”

Drug Abuse 💊

NG-033 PHARMACOLOGY ADHD-friendly visual edition

Alcohol & Drug Abuse on the NCLEX is three things: the 6 key definitions they test you on, the signs & symptoms that give away which substance is on board, and the nursing interventions & medications that follow. Learn the words, then read the body.

📄 Simple Nursing original — opens in Drive →

🦷 Meth = teeth · 👃 Coke = noseMeth = dental problems. Cocaine = nasal damage.
💤 Opioids = 4 S’sSmall pupils · Slow breathing · Slurred speech · Sleepy.
🌊 Withdrawal flips itRunny nose · sweats · insomnia · dilated pupils.
🛏️ 1st = safety & sleepFirst-line intervention in substance abuse disorders.
🗝️

WORDS

STEP 1 · 6 KEY DEFINITIONS

Half of these questions are vocabulary in a costume — name the word and the answer appears.

📖 The 4 body words

1

TOLERANCE 📉

decreased response to a drug / alcohol

2

WITHDRAWAL 🌊

symptoms that develop after abruptly stopping drugs / alcohol

3

DEPENDENCE 🔗

the body’s physical addiction to a drug / alcohol

4

RELAPSE 🔁

the recurrence of drug / alcohol use after remission

🧠 “More · Must · Miss · Meet again.” Tolerance = you need more. Dependence = your body must have it. Withdrawal = your body screams when it misses it. Relapse = you meet again after remission.

🗣️ The 2 family words NCLEX TIP

5. Denial & projection
6. Enabling & codependence

These are what the family says — the exam hands you a quote and asks you to name the behavior:

“It is my fault that my spouse drinks so much”
“I will take care of the children so that my spouse can drink”
“I have lied to my spouse’s boss about why he missed work”
🧠 Enabling = “I’ll cover for you.” Lying to the boss, covering the kids, cleaning up the mess — every one of those sentences keeps the drinking possible.

⭐ NCLEX TIPS — name that word

HESI Patient with chronic pain… a regular dose of analgesic medication is ineffective in reducing the patient’s pain?

➡️ The patient is showing signs of tolerance

ATI …client who abuses alcohol & illicit drugs… spouse tells the nurse: “have lied to his boss, his children, and his friends and I just don’t think I can do this anymore.” Which best describes this behavior?

➡️ Enabling

Both answers are just definition #1 and definition #6 wearing a story. 🎭

🧠 Same dose, less effect = tolerance. Same mess, someone else cleans it = enabling.
👀

WATCH

STEP 2 · SPOT THE SUBSTANCE

Uppers push the vitals UP. Opioids pull everything DOWN. Withdrawal flips the opioid picture over.

🎚️ The dial: uppers push UP, opioids pull DOWN

⚡ STIMULANTS cocaine · methamphetamines ▲ heart rate & blood pressure HIGH NORMAL LOW 💤 OPIOIDS ▼ respiratory rate & LOC down to sedation & coma

⚡ Stimulants — cocaine & methamphetamines act on the brain, so heart rate and blood pressure climb toward HIGH.

💤 Opioids — respiratory rate, pupils and level of consciousness all slide toward LOW (RR norm 12 – 20).

The NORMAL band in the middle is what you are comparing every vital sign against.

🧠 “Uppers UP, opioids OUT.” Cocaine & meth drive HR & BP toward HIGH; opioids drag breathing & consciousness toward LOW.

⚡ Stimulants — Cocaine & Methamphetamines

Cocaine & Meth. or Methamphetamines are both stimulants that act on the brain to increase the heart rate & blood pressure.

Body clue 🔍Substance
Dental problems 🦷Methamphetamines
Nasal damage 👃Cocaine

HESI Q1: …significant dental problems. The nurse expects that this patient abuses which substance? ➡️ Methamphetamines NCLEX TIP

HESI Q2: The nurse finds that a patient who is a drug addict has nasal damage. Which substance does the nurse suspect? ➡️ Cocaine NCLEX TIP

🧠 Meth wrecks the Molars · Cocaine wrecks the Cartilage (nose). Same first letter, same body part.

💤 Opioids — signs & symptoms

  • Decreased respiratory rate (norm: 12 – 20)
  • Narrowed “constricted” pupils
  • Sedation & coma
  • Slurred incoherent speech

KAPLAN A client uses heroin several times a day. Which signs and symptoms does the nurse expect? Select all that apply.

➡️ Constricted pupils · Depressed respirations · Drowsiness or sedation · Slurred incoherent speech

🧠 The 4 S’s of opioids on board: Small pupils · Slow breathing · Slurred speech · Sleepy (sedation → coma).

🚨 The vital sign that wins the question

Respiratory rate (breaths/min) < 12 DECREASED 🚨 12 – 20 expected range 10 → the answer when they ask “most concerning”

HESI Which vital sign would be most concerning to the nurse?

➡️ Respirations 10 breaths/min

Normal is 12 – 20 — a decreased respiratory rate is the opioid finding that outranks everything else on the flow sheet.

🧠 Opioids don’t kill by pain — they kill by pauses. Breathing is always the vital sign to grab first.

🌊 Opioid withdrawal — the mirror image

💤 OPIOIDS ON BOARD CONSTRICTED “pinpoint” ⇄ THE FLIP stop the drug 🌊 OPIOID WITHDRAWAL DILATED pupils
💤 Opioids ON board🌊 Opioid WITHDRAWAL
Pupils 👁️Narrowed “constricted”Dilated pupils
Sleep 😴Sedation & comaInsomnia
Skin & nose 💧—Runny nose · Diaphoresis (sweating)
🧠 “RIDD” — the body trying to get rid of the drug: Runny nose · Insomnia · Diaphoresis · Dilated pupils.
💊

TREAT

STEP 3 · SAFETY FIRST, THEN MEDS

Safety and sleep come before everything else — then the three medication names.

✅ Nursing interventions — first-line first

1
🛏️ Providing safety and sleep NCLEX TIP
the first-line intervention in substance abuse disorders HESI
2
🕯️ Provide a calm atmosphere
for the agitated client who fights against the nurse
3
🫀 Monitor respiratory and cardiac status
stimulants drive HR & BP up — opioids drive respirations down

KAPLAN The client is agitated and fights against the nurse… positive for cocaine… priority intervention?
➡️ Provide a calm atmosphere and monitor respiratory and cardiac status

🧠 “Safe · Sleep · Serene · Scan.” Safety and sleep come first, then a serene (calm) room, then scan the respiratory & cardiac status.

💊 Treatment — 3 drug names NCLEX TIP

DrugWhat it does
NaltrexonePrevents relapse by reducing cravings
ClonidineLowers BP
MethadoneLow dose opioid (wean off addiction)

HESI …teaching a patient with a new prescription for naltrexone?
➡️ “It helps prevent relapse by reducing your drug cravings”

🧠 Naltrexone = No cravings · Clonidine = Calms the pressure down · Methadone = a Measured dose to wean off.

🧾 Which meds treat opioid withdrawal? ATI

Treatment for opioid dependence… which medications are used for treatment of opiate withdrawal? Select all that apply.

✅ Clonidine
✅ Methadone — low dose opioid

Methadone is a low dose opioid used to wean off addiction; Clonidine lowers BP.

Naltrexone was not on that withdrawal list — its job is preventing relapse by reducing cravings.

🧠 C + M carry you through the Coming-off. N keeps you from going back.

🔁 Where each drug sits on the timeline

🌊 WITHDRAWAL — runny nose · sweats · insomnia · dilated pupils
▼
💊 Clonidine (lowers BP) + Methadone (low dose opioid to wean off)
▼
🛡️ Naltrexone — prevents relapse by reducing cravings
🧠 Relapse is definition #4 — the recurrence of drug/alcohol use after remission. Naltrexone is the drug aimed straight at it.
⚡

QUICK RECALL

SAY IT OUT LOUD
🚨 Respirations 10/min= the most concerning vital sign (norm 12–20)
⚡ Stimulants ⬆ HR & BPCocaine + Meth act on the brain
👁️ Pinpoint vs DilatedPinpoint = on board · Dilated = withdrawal
💊 C + M vs NClonidine + Methadone = withdrawal · Naltrexone = no cravings
🎯 Cover & check — 4 rapid-fire questions
Q1: A regular dose of analgesic no longer relieves a chronic-pain patient’s pain. What is this?
Tolerance — decreased response to a drug/alcohol.
Q2: A spouse says “I have lied to his boss, his children, and his friends…” — what behavior is this?
Enabling.
Q3: Significant dental problems → which substance? Nasal damage → which substance?
Dental = Methamphetamines. Nasal = Cocaine.
Q4: Which medications are used to treat opiate withdrawal?
Clonidine and Methadone. (Naltrexone prevents relapse by reducing cravings.)