Question 1

A nurse is obtaining an admission history on a patient who reports daily drinking for several years. When the nurse questions the patient further, the patient reports drinking up to five or six drinks each day. The patient expresses worry about liver damage. What will the nurse do?

A) Contact the patient's provider to request liver function studies.
B) Explain that hepatitis, progressing to severe liver impairment, is likely.
C) Inform the patient that the history indicates that cirrhosis is likely to occur.
D) Tell the patient that stopping drinking will reverse any effects on the liver.

Accepted Answer

Chronic drinking can lead to hepatitis in about 90% of heavy users. The nurse would be correct to request laboratory studies of liver function. Until the laboratory values are known, the degree of damage to the liver is unknown, so the likelihood of severe outcomes cannot be predicted. Acute drinking causes the accumulation of fat and protein in the liver, which is reversible, but this may not be the case with chronic drinking.

Question 2

A patient who has undergone treatment for alcoholism several times, with relapse occurring shortly after each treatment, has just completed detoxification. The patient requests a medication to help maintain abstinence. Which drug will the nurse expect the provider to prescribe?

A) Acamprosate [Campral]
B) Chlordiazepoxide [Librium]
C) Disulfiram [Antabuse]
D) Naltrexone [ReVia]

Naltrexone [ReVia]

Accepted Answer

Naltrexone helps reduce the craving for alcohol and blocks its reinforcing effects. It has been shown to be more effective than acamprosate, which acts by reducing the unpleasant feelings associated with abstinence. Chlordiazepoxide is used for detoxification to minimize acute effects associated with withdrawal. Disulfiram causes severe, uncomfortable, and sometimes life-threatening symptoms when alcohol is consumed and is not widely used.

Question 3

A patient who is an alcoholic is prescribed disulfiram [Antabuse] to help prevent relapse and the nurse provides teaching about the use of this drug. Which statement by the patient indicates understanding of the teaching?

A) "I may use alcohol in cooking since heating foods destroys the alcohol."
B) "I should avoid shaving lotion and mouthwashes that contain even small amounts of alcohol."
C) "If I decide to drink, I should stop taking the disulfiram at least one week prior to consuming alcohol."
D) "If I use alcohol, the effects will be uncomfortable but are not dangerous."

"I should avoid shaving lotion and mouthwashes that contain even small amounts of alcohol."

Accepted Answer

Patients taking disulfiram should be counseled to avoid alcohol in any form and to avoid even alcohol applied to the skin. Alcohol in cooking must be avoided as well. Disulfiram effects will persist up to 2 weeks after taking the medication, so it is not safe to consume alcohol within a week of the last dose. Disulfiram, combined with alcohol, may produce fatal effects.

Question 4

A patient asks a nurse about the effects of chronic alcohol use on the heart. The nurse's best response would be which statement?&#10;A) &#34;Chronic alcohol use affects the liver more adversely than it does the heart.&#34;&#10;B) &#34;Drinking more than two drinks a day protects the heart from atherosclerosis.&#34;&#10;C) &#34;Long-term alcohol use can damage the heart and cause heart failure.&#34;&#10;D) &#34;Over time, alcohol use can lower your blood pressure.&#34;

Accepted Answer

Chronic abuse of alcohol results in direct damage to the myocardium, increasing the risk of heart failure. Chronic alcohol abuse has a significant effect on the heart and also affects the liver. Drinking fewer than two alcoholic beverages a day potentially protects the heart from atherosclerosis. Alcohol consumption produces a dose-dependent elevation of blood pressure.

Question 5

A pregnant patient in labor tells the nurse that she is afraid she may have harmed her fetus by consuming alcohol. What is an appropriate response by the nurse?&#10;A) Ask the patient how much alcohol she consumed, and at which stage of her pregnancy.&#10;B) Reassure the patient that the risk is likely to be minimal.&#10;C) Tell the patient that no amount of alcohol is considered safe during pregnancy.&#10;D) Tell the patient that the full range of outcomes may not be evident for years.

Accepted Answer

Although heavy use of alcohol has known adverse effects on the fetus, the effects of lower levels are unknown. The nurse should first question the patient about the amount of alcohol consumed at which stages of pregnancy to better determine the potential risk. Many women consume alcohol before knowing they are pregnant without any seeming ill effects. Reassuring this patient that her risks are low is not appropriate without further information. Moreover, reassuring her without getting more information only belittles her fears. Telling a patient that no amount of alcohol is safe during pregnancy would be an appropriate intervention during counseling of a woman who has just discovered she is pregnant; however, it would only intensify the fears of this patient. Telling the patient that the outcomes will not be evident for years would only intensify her fears.

Question 6

A college student who is unresponsive is brought to the emergency department by friends, who say that their friend drank more than half of a large bottle of whiskey 3 hours ago. Assessment reveals a blood alcohol level of 0.32%. The vital signs are BP, 88/32 mm Hg; R, 6/min; T, 96.8°F; and P, 76/min and weak and thready. The nurse should prepare the patient for which intervention?

A) IV fluids and stimulants
B) Charcoal administration
C) Gastric lavage and dialysis
D) Naloxone [Narcan] administration

Accepted Answer

The average rate at which a person can metabolize alcohol is about 15 mL (0.5 ounce) per hour. The patient in this scenario has consumed more than half of a large bottle of whiskey within 3 hours. Alcohol can be removed from the body by gastric lavage and dialysis. Gastric lavage "washes out" most of the alcohol if any is left in the gut, and dialysis is implemented to reduce the chance of renal failure and cardiovascular shock. Although intravenous fluids may be appropriate, stimulants are contraindicated for this patient. Charcoal is not indicated in this situation. Naloxone is indicated in opiate overdoses, not alcohol overdoses.

Question 7

A nurse is screening a patient being admitted to the hospital. The patient reports being fired for drinking at work. On further questioning, the patient reveals a history of daily alcohol consumption of more than six packs of beer each day, regular morning drinking, and several unsuccessful attempts to stop drinking. The nurse detects alcohol on the patient's breath. The nurse will inform the provider of these findings and request an order for which medication?

A) Chlordiazepoxide [Librium]
B) Clonidine
C) Disulfiram [Antabuse]
D) Naltrexone [ReVia]

Accepted Answer

This patient shows signs of alcohol use disorder, according to the AUDIT Screening Instrument, and has a score of at least 21 points from the information included in this history. A score of 8 or higher for men up to age 60 and a score of 4 or higher for others are positive screening results. The patient recently has consumed alcohol, as evidenced by the detectable smell, although the amount consumed and the time since the last drink cannot be determined. Because this patient is an active alcoholic, the risk of withdrawal symptoms is high; therefore, the patient needs medication to facilitate withdrawal. Benzodiazepines are the safest, most effective medications for this purpose, and those with longer half-lives, including chlordiazepoxide, are preferred. Clonidine is useful as an adjunct to help reduce autonomic symptoms associated with withdrawal. Disulfiram is used to maintain abstinence; its use along with alcohol can produce dangerous symptoms. Naltrexone is used to maintain abstinence by reducing cravings; it does not facilitate withdrawal.

Question 8

A patient tells a nurse that she drinks wine for its cardioprotective effects. She wants to know how much is safe. The nurse is correct in telling her that:&#10;A) &#34;A couple of glasses of wine 1 or 2 days a week will help prevent heart disease.&#34;&#10;B) &#34;Abstaining from alcohol completely is the best way to prevent heart disease.&#34;&#10;C) &#34;If you drink only on weekends, you will minimize your risk of developing heart disease.&#34;&#10;D) &#34;Cardioprotective effects are greatest in people who live an unhealthy lifestyle.&#34;

Accepted Answer

Moderate consumption, which for women is 1 drink a day or less, has been shown to reduce the incidence of ischemic stroke, coronary artery disease, myocardial infarction, and heart failure. The pattern determines protection as well; moderate consumption 3 or 4 days a week rather than 1 or 2 days is more protective. These effects are greatest in people who have an unhealthy lifestyle, who do not eat fruits and vegetables, and who smoke. Having a couple of glasses of wine exceeds the moderate amount for women. Moderate consumption, as just described, has better protective benefits than complete abstinence. Drinking on weekends does not fit the pattern of 3 or 4 days per week that has been shown to be protective.

Question 9

A male patient tells a nurse that he drinks six packs of beer a day. When the nurse begins to question him further about his alcohol consumption, he says, "You sound like my wife. She's always nagging me to quit. It's only beer!" Which response by the nurse is most appropriate?

A) "Because the alcohol in beer is diluted in a larger volume, it is absorbed more slowly."
B) "Have you considered switching to wine? It has chemicals that protect your heart."
C) "The amount you drink is equivalent to six shots of whiskey each day."
D) "You could try to cut the amount in half to a level that is better for your health."

Accepted Answer

The amount of alcohol in one can of beer is equivalent to the amount in a shot of whiskey or 1 glass of wine. Even though the amount per volume of fluid is less in beer, the absorption of the alcohol does not change; it just may take longer to consume it. Even though red wine contains resveratrol, which may reduce cardiovascular disease, the amount is too small to have significant effects and would be offset by the amount this man consumes on a daily basis. It is not likely that someone already accustomed to consuming six cans of beer a day would be able to cut the amount in half. Moreover, daily drinking in itself may still constitute an alcohol use disorder, depending on other factors.

Question 10

A nursing student asks a nurse to discuss alcoholism and alcohol use disorder. Which statement by the nurse is correct?&#10;A) &#34;Alcohol use disorder can occur without the development of tolerance or physical dependence.&#34;&#10;B) &#34;Individuals with alcohol use disorder develop cross-tolerance with opioid analgesics.&#34;&#10;C) &#34;Initial symptoms of abstinence syndrome occur within 1 to 2 hours after withdrawal of alcohol.&#34;&#10;D) &#34;With severe alcoholism, most alcoholics have delirium tremens when alcohol is withdrawn.&#34;

Accepted Answer

Alcohol abuse can occur without the development of tolerance or physical dependence, although these generally develop with long-term use of alcohol. Cross-tolerance occurs between alcohol and general anesthetics and other CNS depressants, but not with opioids. The symptoms of abstinence syndrome begin to manifest 12 to 72 hours after the last drink. Fewer than 1% of alcoholics experience delirium tremens.

Question 11

A nurse is providing education to a group of college students about the long-term effects of alcohol. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Chronic alcohol use contributes to the development of osteoporosis.&#34;&#10;B) &#34;Chronic use of alcohol can actually decrease the risk of cardiomyopathy.&#34;&#10;C) &#34;Even small amounts of alcohol are related to the development of certain cancers.&#34;&#10;D) &#34;Pancreatitis is not a common problem among chronic users of alcohol.&#34;

Accepted Answer

The answer of A nurse is providing education to a...

Question 12

A nurse is discussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that, in moderate amounts, alcohol:&#10;A) helps people to sleep well.&#10;B) improves sexual responsiveness.&#10;C) may protect against dementia.&#10;D) prevents hypothermia.

Accepted Answer

The answer of A nurse is discussing alcohol abuse with...

Question 13

A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient?&#10;A) Acetaminophen&#10;B) Diazepam&#10;C) Morphine&#10;D) Thiamine

Accepted Answer

The answer of A patient who is an active alcoholic...

Question 14

During a health history, the nurse asks a male patient about alcohol use. The patient tells the nurse that he and his wife are trying to conceive a pregnancy and he is using alcohol to lower his inhibitions. What will the nurse counsel this patient?

A) "Alcohol causes increased masculinization."
B) "Alcohol may cause testicular atrophy and sterility."
C) "Alcohol will improve your chances of conceiving."
D) "Alcohol will also help you to ejaculate."

Accepted Answer

The answer of During a health history, the nurse asks...

Question 15

A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood alcohol level is 0.4%. The nurse will expect to:

A) find that the patient has lost consciousness within a short time.
B) administer naltrexone [ReVia] and prepare for gastric lavage.
C) give carbamazepine to reduce the risk of seizures.
D) provide mechanical ventilation and oxygen.

Accepted Answer

The answer of A patient is brought to the emergency...

Question 16

An alcoholic patient's spouse asks a nurse about recovery from chronic alcoholism. The patient is confused and has abnormal eye movements and nystagmus. Which statement by the nurse is correct?&#10;A) &#34;The symptoms your spouse shows are partly reversible in most people.&#34;&#10;B) &#34;These symptoms can be reversed with vitamin therapy and good nutrition.&#34;&#10;C) &#34;Your spouse has symptoms of an irreversible encephalopathy.&#34;&#10;D) &#34;Your spouse will probably recover completely after detoxification.&#34;

Accepted Answer

The answer of An alcoholic patient's spouse asks a nurse...

Deck 38: Drug Abuse II: Alcohol