Deck 22: Substance Abuse

Question 1

The adolescent patient is in a drug rehabilitation program. The mother of this patient says to the nurse, "The doctor said my son has a physical addiction to alcohol. What does this mean?" What is the best response by the nurse?

A) "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it."
B) "He will have an intense craving for alcohol; this is best managed in group therapy."
C) "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped."
D) "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide."

Answer 1

"His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped."

Question 2

The nurse would expect to see which withdrawal symptoms from a patient who abuses alcohol?

A) Lethargy, constipation, light sensitivity, and weight loss
B) Anxiety, seizures, hearing loss, and alopecia
C) Tremors, anxiety, confusion, and delirium
D) Abdominal pain, chills, pupil dilation, and lethargy

Answer 2

Tremors, anxiety, confusion, and delirium

Question 3

A hospice patient has been receiving oral pain medication for several weeks. The patient started with 4 mg of the drug, and each week has had to increase the amount by 2-3 mg to obtain adequate pain relief. The nurse recognizes that the patient

A) has developed immunity to the drug.
B) has developed a tolerance to the drug.
C) has developed a physiologic addiction to the drug.
D) has developed a psychological addiction to the drug.

Answer 3

has developed a tolerance to the drug.

Question 4

When an individual wants to stop using a drug but can't, she would be suffering from

A) psychological dependence.
B) substance dependence.
C) physical dependence.
D) withdrawal syndrome.

Question 5

The patient comes to the emergency department and tells the nurse, "I am going to get clean. I haven't had any drugs or any alcohol for 2 days." The nurse plans care based on the knowledge that withdrawal from which substance can be life threatening?

A) Heroin
B) Alcohol
C) Cocaine
D) Marijuana

Question 6

During a health history, the nurse should use therapeutic communication when asking about substance abuse. Which of the following is essential to establish a trusting nurse-patient relationship?

A) Informing the patient that substance abuse is a sin
B) Avoiding communicating disapproval of indicated substance abuse
C) Ensuring that the patient's mother and father are at the bedside
D) Avoiding shocked facial expressions

Question 7

Which questions would the nurse ask to assess for the presence of user-related factors in a patient with substance use disorder?

A) "How many friends do you consider to be reliable?"
B) "Does anyone in your family have a substance use disorder?"
C) "Have you had any disorders for which you have taken prescription pain medications?"
D) "What is the highest level of education you completed?"
E) "How much disposable income do you have?"

Question 8

What is a priority outcome for the patient who has chronic alcoholism with liver damage?

A) The patient will switch to a safer drug, like a benzodiazepine.
B) The patient will become involved in Alcoholics Anonymous (AA).
C) The patient will keep all appointments with the doctor treating his liver damage.
D) The patient will learn to drink more responsibly.

Question 9

A patient expresses concern about becoming addicted to a prescription pain medication ordered postoperatively. What nursing responses are indicated?

A) "The dose of your medication is as low as possible."
B) "You will only take the medication for a short time."
C) "If you follow the suggested schedule, you have little risk of addiction."
D) "If you need this medication, you cannot become addicted to it."
E) "Take the medication now, and we will worry about addiction later."

Question 10

The patient is withdrawing from opioids. Which symptoms best describe the results of the nurse's assessment?

A) Abdominal cramping and pain
B) Positional fluctuations in blood pressure
C) Hot, dry skin
D) Goose bumps
E) Agitation

Question 11

The patient had been abusing cocaine for several years. Recently, the patient snorted cocaine that was much purer than was thought, resulting in an overdose. The patient died in the emergency department. What does the nurse recognize as the most likely cause of death?

A) Cardiac arrest
B) Rhabdomyolysis
C) Impurities in the cocaine
D) Bowel ischemia

Question 12

The patient tells the nurse that her 12-year-old child asks to use her nail polish remover several times a day. When her friends come to visit, this seems to occur more frequently. What is the best response by the nurse?

A) "Your daughter may be 'huffing'; that is really scary."
B) "Your daughter may be 'huffing' or inhaling the remover."
C) "Your daughter may be 'huffing' or drinking small amounts of the remover."
D) "Your daughter may be 'huffing' or rubbing the remover on her skin."

Question 13

The patient has smoked a pack of cigarettes per day for 20 years. The patient also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include?

A) "You are at a higher risk for a heart attack than nonsmokers."
B) "The nicotine will decrease the effectiveness of your birth control pills."
C) "You are at a higher risk for developing diabetes than smokers who do not use birth control pills."
D) "You are at a higher risk for emphysema than nonsmokers."

Question 14

Which drug is least likely to produce physical dependence or tolerance?

A) Marijuana
B) Morphine
C) Nicotine
D) Ethyl alcohol

Question 15

The mother of an adolescent patient says to the nurse, "I think my son is staying up too late studying. He seems listless, and I see him using eye drops all the time for his red eyes. Should I have his vision checked?" What is the best response by the nurse?

A) "He might be depressed; insomnia is common with depression."
B) "He could be smoking marijuana, and I would talk to him."
C) "Sounds like he is using cocaine; I have seen this before."
D) "Yes, that is a great idea; he may need some glasses."

Question 16

The patient has been abusing alcohol for several years and tells the nurse, "I used to drink a pint of whiskey every day. Now I get sick and pass out after just two drinks." What does the nurse correctly recognize about this patient?

A) The patient's symptoms are related to hyperglycemia; he may have pancreatic damage.
B) The patient may have liver damage, resulting in an inability to metabolize large amounts of alcohol.
C) The patient is in denial and is most likely minimizing the amount of alcohol he consumes.
D) The patient has brain damage from the alcohol and cannot remember how much he consumes.

Question 17

The patient is admitted to the in-patient substance abuse unit. She tells the nurse she has been buying "yellow jackets" (pentobarbital, [Nembutal]) on the street but hasn't had any for a few days. What is the best plan by the nurse at this time?

A) Prepare to manage the depression and suicidal thoughts the patient will have.
B) Prepare to do frequent room searches, as the patient's friends will most likely bring drugs in for her.
C) Prepare to manage a withdrawal that could be life threatening.
D) Prepare to manage a withdrawal that will likely be minimal.

Question 18

The patient has been prescribed disulfiram (Antabuse) to discourage a return to drinking alcohol. The patient tells the nurse that after stopping disulfiram (Antabuse) for a week, he returned to drinking alcohol. What will the nurse most likely assess in the patient?

A) Headache, nausea, and vomiting
B) Confusion and fine tremors
C) An absence of symptoms, as the drug was discontinued
D) Severe hyperglycemia and dry skin

Question 19

The nurse is managing care for a group of patients with substance use disorder. The patients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the patients make which statements?

A) "Heroin addicts often die from heroin withdrawal."
B) "Substance abuse depends on complex variables."
C) "Most addicts became addicted from pain medication in a hospital."
D) "Addiction includes a compulsion to use a mood-altering substance."
E) "There is most likely a genetic component to addiction."

Question 20

The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon?

A) The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient.
B) The patient has developed a paradoxical reaction to the anesthesia and will require a different drug.
C) The patient has developed a resistance to the anesthesia, so it will not work very well.
D) The patient has developed cross-tolerance to the anesthesia and will require higher amounts.

Question 21

The nurse is providing community education regarding marijuana. Which information should be included?

A) THC is the ingredient that causes most of the psychoactive effects.
B) Metabolites of marijuana can be detected in the urine for several days after last use.
C) Metabolites of marijuana can be detected in the body for months to years after last use.
D) The only medical use for marijuana is for glaucoma.
E) Smoking marijuana results in a greater accumulation of tar in the lungs than does cigarette smoking.

Question 22

The nurse is providing education for a patient who desires to stop taking heroin. Which information should be included?

A) "You are probably going to have some withdrawal symptoms, but there are medications that can help you."
B) "Expect to remain on methadone for a long while."
C) "Methadone will give you the same high as the heroin you have been using."
D) "You will need a supply of syringes and needles for your methadone treatment."
E) "Methadone will not cause any withdrawal symptoms"

Question 23

The nurse is preparing care for a patient diagnosed with substance abuse of a Schedule I drug. Which drugs could be implicated?

A) Methcathinone (Cat)
B) Ritalin
C) LSD
D) Cocaine
E) Mescaline

Question 24

A patient has been abusing an antianxiety medication. Which assessment by the nurse would confirm this is psychological dependence instead of physical dependence?

A) The patient's history reveals the long-term use of high doses of an antianxiety medication.
B) The patient describes the "need" to use the antianxiety medication despite not feeling anxious.
C) The patient describes feeling nauseous with abdominal cramping.
D) The patient tells you her family has "disowned" her because of her need for the antianxiety medication.
E) The patient complains she has not slept in days, feels anxious, and is tired.

Question 25

A patient suffering from tachycardia and palpitations would most likely be experiencing the signs of drug toxicity from which of the following?

A) Nicotine
B) Alcohol
C) Benzodiazepines
D) Marijuana

Question 26

A patient in the emergency department says, "I am having bad effects from the marijuana I smoked this morning." The nurse formulates a response based on knowledge that effects of marijuana may last up to ____ hours.
Standard Text: Record your answer rounding to the nearest whole number.

Question 27

The nurse is reinforcing factors that contribute to addiction to a group of patients recovering from addiction and their family members. Which statement made by a patient or family member would indicate the need for additional teaching?

A) "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction."
B) "I can still see my friends as long as I stay away from alcohol."
C) "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to."
D) "I realize now that I was just looking for ways to help me feel good about myself."
E) "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills."

Question 28

A nurse is preparing to admit a patient suspected of overdose. The nurse knows to suspect which drugs as being the most commonly abused?

A) Methylphenidate (Ritalin)
B) Nicotine
C) Marijuana
D) Amobarbital (Amytal)
E) Secobarbital (Seconal)

Question 29

A patient must eliminate caffeine intake due to contraindication with a newly prescribed medication. The nurse should advise the patient to prepare for which withdrawal symptoms?

A) Depression
B) Insomnia
C) Weight gain
D) Urinary retention
E) Headache

Question 30

The nurse manager is presenting an educational session on the issue of substance use disorder and nurses. The manager would focus information on which substances?

A) Barbiturates
B) Benzodiazepines
C) Alcohol
D) Hallucinogens
E) Opioids