Deck 6: Nursing Care of Patients with Problems of Substance Abuse

Question 1

A patient with a history of chronic alcohol use is underweight and malnourished. Which of the following may be prescribed to manage the patient's nutritional status?

A)vitamin B₁
B)diazepam
C)methadone
D)Narcan

Answer 1

vitamin B₁

Question 2

A patient, admitted with seizures, is diagnosed with a perforated nasal septum. The nurse realizes that this patient most likely has abused which of the following substances?

A)cocaine
B)marijuana
C)alcohol
D)barbiturates

Answer 2

cocaine

Question 3

Which of the following assessment findings would indicate that a patient's risk for alcohol abuse is low?

A)is from the Asian cultural group
B)diagnosed with type 2 diabetes
C)has two children
D)employed as an accountant

Answer 3

is from the Asian cultural group

Question 4

Which of the following warning signs would indicate that a nurse is experiencing depression associated with substance abuse?

A)leaves the unit and unable to be located for long periods of time
B)uses the visitor bathroom instead of employee bathroom
C)wastes prescribed narcotics several times each shift
D)complains of a stomach ache every day at work

Question 5

A patient is brought into the emergency department with a gunshot wound obtained while attempting to rob a convenience store. For which of the following health problems should this patient be assessed?

A)drug and alcohol abuse
B)cardiovascular disease
C)respiratory disease
D)mental health disorder

Question 6

A patient tells the nurse that both of his parents are alcoholics and wonders about the likelihood of becoming an alcoholic as well. With which of the following should the nurse respond to this patient?

A)"There are studies that support a genetic link for developing alcoholism."
B)"Why are you concerned about becoming an alcoholic"
C)"You will likely become an alcoholic."
D)"Don't worry about that."

Question 7

A patient comes to the emergency department with a PCP overdose. Which of the following interventions can the nurse anticipate that the patient will need?

A)Administer Haldol as prescribed.
B)Induce vomiting.
C)Obtain materials to assist with lavage.
D)Administer Narcan as prescribed.

Question 8

A patient tells the nurse that he becomes very angry and abusive to his friends and family when he is unable to obtain an illegal substance. With which of the following should the nurse respond to this patient?

A)"Have you considered seeking treatment for this behavior"
B)"You must not have many friends left."
C)"Are you this argumentative when at work"
D)"What does your family say about this"

Question 9

A patient, recovering from out-patient carpal tunnel surgery, returns to the surgical center the next day and tells the nurse that the pain is "excruciating" and wants stronger pain medication now. Which of the following does this suggest to the nurse?

A)The patient could have a substance abuse problem.
B)A nerve was cut during the procedure.
C)The patient was not given strong enough postoperative pain medication.
D)The patient is under stress to return to work.

Question 10

A nurse is concerned about potential substance abuse by a coworker. Which of the following behaviors warrants further investigation?

A)The coworker frequently wastes medications.
B)The coworker frequently requests the largest patient care assignment for the shift.
C)The coworker prefers not to be the "medication nurse" on the shift.
D)The coworker declines to take scheduled breaks.

Question 11

The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. The nurse realizes that

A)the patient's biological parents might have abused alcohol.
B)the patient spent time drinking with friends.
C)consuming alcohol is a symptom of stress.
D)alcoholism is a learned behavior.

Question 12

After surgery, the nurse notes a patient is unable to achieve pain relief from the analgesics prescribed. A review of the patient's medical records reveals a history of alcohol abuse. What inferences can the nurse make?

A)The patient is likely cross-tolerant to the prescribed analgesic.
B)The patient has an unreported addiction to the pain medication being prescribed.
C)The patient has a history of using this medication at home.
D)The patient has a dual diagnosis relating to alcohol and drug addiction.

Question 13

A patient tells the nurse that she started to have a glass of wine every evening at home after work to "unwind" and then realized that she cannot continue with her day unless she has the wine. The nurse realizes that this patient used wine to

A)cope with day-to-day problems.
B)deal with difficulty expressing emotions.
C)suppress a genetic need for alcohol.
D)socialize with others.

Question 14

A nurse consistently arrives to work wearing a long-sleeved blouse despite the temperature as being warm and humid. When colleagues mention her attire, the nurse becomes defensive and isolates herself from others. Which of the following does the nurse's behavior suggest?

A)substance abuse
B)a long-standing illness
C)introverted behavior
D)low self-esteem

Question 15

The nurse manager is concerned that one staff nurse is demonstrating signs of substance abuse. Which of the following behaviors did the manager observe in the staff nurse? Select all that apply.

A)Calling for days off or illness before scheduled days off
B)using the bathroom frequently
C)excessive use of mouthwash
D)volunteering to transfer a patient to the intensive care unit
E)following up with nursing assistants on patient care needs

Question 16

A patient is brought into the emergency department with dilated pupils, respiratory rate of six per minute, and seizure activity. Which of the following should the nurse prepare to administer to this patient?

A)Narcan
B)activated charcoal
C)ammonium chloride
D)Diazepam

Question 17

A patient comes into the emergency department wanting to be checked for sexual activity since she was out the other night at a rave and cannot remember what occurred. The nurse realizes that which of the following addictive substances would cause this effect in the patient?

A)ecstasy
B)crank
C)marijuana
D)alcohol

Question 18

A patient, complaining of back pain, tells the nurse that he needs several refills on any prescription since he takes the medication more frequently than prescribed. Which of the following does this information suggest to the nurse?

A)The patient has lost control over the consumption of the pain medication.
B)The patient is impulsive.
C)The patient uses the pain medication to fit in with a peer group.
D)The patient uses the pain medication to overcome low self-esteem.

Question 19

A teenage patient, brought to the emergency department by his parents, was reported to have taken barbiturates with alcohol. Which of the following will be the greatest concern for this patient?

A)respiratory depression
B)seizure activity
C)signs of withdrawal
D)signs of hallucinations

Question 20

A patient involved in a minor accident reports having used "crank" an hour ago. The patient denies having used the drug before. Which of the following manifestations can the nurse anticipate occurring with this patient?

A)report feelings of increased strength and intelligence
B)display increased strength and cognition
C)drowsiness
D)exhibit hallucinations and paranoia

Question 21

The patient is exhibiting some addictive behaviors and has been admitted to using illegal drugs. Which of the following statements by the patient are consistent with addictive behaviors? Select all that apply.

A)"I think even as a child I was much more anxious than my friends."
B)"When I was in the hospital for appendicitis, they told me they had to give me more pain medications than normal because I was still in pain."
C)"Sometimes I steal things from stores just to see if I can get away with it."
D)"I like to play it safe.When my friends were bungee jumping off the bridge, I just watched."
E)"I have always been very slow to anger."

Question 22

The patient has consumed 660 milligrams of caffeine during the last eight hours. The patient states that he consumes this amount of caffeine on a regular basis. After reviewing the information included in the chart above, which of the following statements by the patient is consistent with the information provided? 11ea992e_0a8e_3b02_9f38_2b4fc2df02dc

A)"I don't know why but I just can't get to sleep."
B)"I always feel cold."
C)"I have been so constipated."
D)"I have no appetite."

Question 23

The patient states, "I think I am actually addicted to nicotine." Which of the following assessment findings by the nurse are consistent with this type of addiction? Select all that apply.

A)The blood pressure is 182/86.
B)The patient states, "Sometimes, I feel so nauseated after I smoke cigarettes."
C)The patient states, "I have never been able to stop smoking for more than two weeks at a time because the cravings get so bad."
D)An apical heart rate is 72 beats per minute.
E)A respiratory rate is 14 breaths per minute.

Question 24

The patient states she has been using an illegal drug for the last nine years. Based on the information included in the chart above, which of the following statements is most consistent with the type of illegal drug she has been abusing? $$\begin{array} { | l | l | } \hline \text { Assessment } & \text { Results } \\\hline \text { Breath sounds } & \begin{array} { l } \text { Crackles and wheezes auscultated in lower } \\\text { lung fields }\end{array} \\\hline \text { Head, ears, eyes, nose, throat } & \begin{array} { l } \text { Patient complaining of a "runny nose" and } \\\text { sinus pressure }\end{array} \\\hline \text { Reproductive system } & \begin{array} { l } \text { Patient states, "My husband and I have } \\\text { been trying to get pregnant for the last } \\\text { three years without any success." }\end{array} \\\hline \text { Luteinizing hormone } & \text { Decreased } \\\hline \text { Follicle stimulating hormone } & \text { Decreased } \\\hline\end{array}$$

A)"My husband and I smoke our fair share of 'broccoli.'"
B)"I should tell you tell that I drink quite a bit of hootch."
C)"I am probably addicted to 'Big D.'"
D)"I use the 'white stuff.'"

Question 25

The patient has been admitted to the hospital after a motor vehicle accident. The patient states that she frequently smokes "ice" and had smoked some as recently as two hours prior to the accident. Which of the following assessment findings are consistent with this information? Select all that apply.

A)Apical heart rate is 112 beats per minute.
B)Preventricular contractions are noted during electrocardiogram.
C)The patient weighs 92 pounds and is 5'5" tall.
D)The patient is complaining of chest pain.
E)Blood pressure is 96/72.

Question 26

The patient has been admitted to an addiction detoxification unit. The nurse has educated the patient about the medications that have prescribed to help with withdrawal symptoms. Which of the following statements made by the patient indicate that further education is required? Select all that apply.

A)"Naltrexone is an antidepressant."
B)"The Antabuse will help me with my cravings for heroin."
C)"The clordiazepoxide is also called Librium and it can help with my anxiety."
D)"The phenobarbital will help prevent me from having another seizure."
E)"I need folic acid and other vitamin supplements because I haven't eaten well for so long."

Question 27

The patient has been diagnosed with substance dependence. The patient has been using "Bennies" for the last three years. Which of the following patient statements are associated with substance dependence? Select all that apply.

A)"I am so tired and I feel so confused about everything that is happening around me."
B)"I really tried to cut down my use, but I fail miserably every time."
C)"The only thing I care about right now is getting my fix."
D)"I have to use a lot more right now to get the same high as I did before."
E)"I have a great job where I work full-time as a mechanical engineer, so that part of my life is very fulfilling."

Question 28

The patient has been brought to the emergency department after the patient was found by his mother at home. The patient's blood alcohol level is currently 0.51%. Which of the following findings are consistent with this information? Select all that apply.

A)A sternal rub was performed, no response elicited.
B)The patient's respiratory rate is eight breaths per minute.
C)The patient's radial and pedal pulses are bounding.
D)The patient states, "I sleep for a long time, but I never feel rested when I wake up."
E)The patient states, "I really think I can drive myself home.I am fine!"

Question 29

The patient has been included in a research study along with 4,204 other patients who live in the United States. Two thousand two hundred of these patients are male. Of the female patients, how many are likely to be smokers? Round the answer to the nearest whole number.

Question 30

The new nurse has been hired onto a medical-surgical unit. The new nurse is concerned because one of the other nurses has exhibited some signs that may indicate that he has a substance use problem. Which of the following behaviors by the nurse may be consistent with this problem? Select all that apply.

A)The new nurse notes that the other nurse is always sucking on mints and has applied strong-smelling cologne.
B)During the other nurse's break, two of his patients stated they didn't feel like the pain medication that he gave them was working at all.The patients stated that the pain medications had been previously effective.
C)The other nurse has volunteered to "waste" all of the new nurse's narcotic medications.
D)The other nurse has displayed difficulty juggling his patient assignment and seems to be highly unorganized.
E)The narcotic count at the end of the shift is off; two doses of morphine sulfate are missing.

Question 31

A patient has overdosed on benzodiazepines and is admitted in a comatose state. The best order for treatment is which of the following? Click and drag the options below to move them up or down.

A)Clear airway.
B)Prepare to intubate.
C)Vital signs every 15 min.
D)Prepare for gastric lavage.
E)Prepare for possible dialysis.
F)Institute seizure precautions.

Question 32

Abusive substances act at brain receptor sites as agonists or antagonists. Place an "X" on the picture that represents an antagonistic effect.

Question 33

Vitamins the nurse expects an alcoholic patient to receive include which of the following? Select all that apply.

A)thiamine (vitamin B₁)
B)folic acid
C)cyanocobalamin (vitamin B₁₂)
D)vitamin E
E)potassium chloride

Question 34

A patient has substance dependence when clinically significant distress is manifested by which of the following? Select all that apply.

A)tolerance is present
B)substance is taken for longer periods than intended
C)spends more time in private using the substance
D)desire to control substance use
E)persistent continued use despite intrapersonal problems

Question 35

The effects of cannabis sativa (marijuana) are dose related and can include which of the following? Select all that apply.

A)fetal CNS disturbances
B)tachycardia
C)asthma with long term use
D)diuresis
E)hypertension

Question 36

The student nurse is learning about some issues related to substance abuse from an experienced nurse who works in an addiction detoxification unit. The student nurse asks the nurse about the importance of requesting information from the patients about a family history of substance abuse. Which of the following responses by the nurse are appropriate? Select all that apply.

A)"There is a genetic link between having an alcoholic parent and developing problems related to substance use."
B)"These genetic issues are more often related to alcohol, marijuana, and tobacco use."
C)"One type of genetically-related alcoholism is associated with an antisocial personality disorder, early use, and an inability to stop drinking."
D)"The patient has an increased likelihood of developing substance use problems when the mother of the patient is an alcoholic."
E)"Some studies indicate that adolescents who are more genetically prone to develop alcoholism were less likely to have other types of substance use problems."

Question 37

A loading dose of magnesium sulfate 4g is ordered for a patient. The concentration available is 4g/250 mL to be given over 30 minutes. The IV pump will have the rate set at _________().

Question 38

A patient withdrawing from alcohol has an order for diazepam (Valium), 10 mg every 4 hours for 4 doses, then 5 mg every 4 hours for 4 doses. The drug comes in a concentration of 5 mg/mL. The total mL given the patient are_________().

Question 39

During assessment of a patient with a substance abuse, the nurse uses open-ended Select all that apply.

A)On average, how many days a week do you drink or use drugs?
B)How often and how much do you usually use?
C)What is the greatest number of drinks you have had at any one time in the past month?
D)Do you drink beer or whiskey?
E)Did you drink beer before coming to the hospital?

Question 40

The patient has been dealing with chronic alcoholism for the last 25 years. The patient has entered an addiction detoxification unit and has displayed progress with recovery. The nurse has educated the patient regarding some of the long-term effects of alcohol use. Which of the following statements by the patient indicate that the patient requires further education? Select all that apply.

A)"My yellow skin is really just caused by the thiamine deficiency."
B)"My problems with COPD weren't because I smoke; it's because I was drinking so much."
C)"I was surprised to learn that my coronary artery disease may have been worsened by my drinking."
D)"I think I would've stopped drinking a long time ago if I had known that it may have caused my impotence."
E)"My mom was an alcoholic and died from breast cancer and it may have been the result of her drinking."

Question 41

Screening tools that assist in determining the degree of addiction or dependence includes which of the following? Select all that apply.

A)Michigan Alcohol Screening test
B)the CAGE questionnaire
C)Brief Drug Abuse Screening Test
D)the Clinical Institute Withdrawal Assessment of Alcohol-Revised
E)Clinical Opiate Withdrawal Scale

Question 42

Imbalanced Nutrition: Less than Body Requirements is the nursing diagnosis written for a patient hospitalized for substance abuse. Interventions include which of the following? Select all that apply.

A)Monitor the CBC and liver enzymes.
B)Collaborate with the dietician.
C)Administer vitamins and diet supplements.
D)Provide high fat, high carbohydrate diet.
E)Restrict fluid intake to 1500 mL per day.

Question 43

Factors that decrease substance abuse in healthcare workers include which of the following? Select all that apply.

A)strong religious practices
B)treatment for depression
C)role strain
D)workplace stress
E)history of abuse

Question 44

A nurse has been convicted of driving while under the influence. The nurse's license will be affected by which of the following?

A)state board of nursing
B)Employee Assistance Program
C)state court system
D)American Nurses Association