Deck 13: Substance Abuse Assessment and Management

Question 1

A teenager who is brought to the emergency department by the parents is reported to have taken barbiturates with alcohol. What will be the greatest concern for this patient?

A) Respiratory depression
B) Seizure activity
C) Signs of withdrawal
D) Hallucinations

Answer 1

Respiratory depression

Question 2

A patient has been using amphetamines for the last 3 years and has been diagnosed with substance dependence. Which statements by the patient are associated with substance dependence? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "I am so tired and I feel so confused about everything that is happening around me."
B) "I have 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 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."

Answer 2

"I am so tired and I feel so confused about everything that is happening around me."
"I have really tried to cut down my use, but I fail miserably every time."
"The only thing I care about right now is getting my fix."
"I have to use a lot more right now to get the same high as before."

Question 3

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 uses wine for which reason?

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

Answer 3

To cope with day-to-day problems

Question 4

A patient has been admitted to an addiction detoxification unit. The nurse has educated the patient about the medications that have been prescribed to help with withdrawal symptoms. Which statements by the patient indicate that further education is required? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

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

Question 5

The nurse is concerned about possible substance abuse by a coworker. Which behavior 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 6

The nurse manager is concerned that a staff nurse is demonstrating signs of substance abuse. Which behaviors did the manager observe in the staff nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Calling for days off or illness before scheduled days off
B) Using the bathroom frequently
C) Offering to give medication to patients not assigned to the nurse
D) Volunteering to transfer a patient to the intensive care unit
E) Following up with nursing assistants on patient care needs

Question 7

A patient is brought to the emergency department with a gunshot wound inflicted while attempting to steal beer from a convenience store. Which statement by the patient would reflect a sociocultural influence on the patient's behavior?

A) "My dad was killed while driving drunk before I was even born."
B) "I didn't take anything out of that store. The manager is just trying to pin something on me."
C) "There was lots of beer in that store. I didn't see how taking one six-pack would hurt anything."
D) "I can't have fun at a party without beer."

Question 8

A patient who is a recovering alcoholic says, "I haven't had a drink in 10 days. I think I am over the hardest part and will be okay now." The nurse formulates a response based on which information?

A) Symptoms of postacute withdrawal syndrome begin about a month after the last drink.
B) Symptoms of postacute withdrawal syndrome peak from 3 to 6 months after the last drink.
C) The recovering alcoholic is never "okay" again.
D) It is easier to recover from cocaine abuse than from alcohol abuse.

Question 9

A patient involved in a minor accident reports using "crank" an hour ago. The patient denies having used the drug before. Which manifestation can the nurse anticipate assessing in this patient?

A) Feelings of increased energy and happiness
B) Increased strength and coordination
C) Drowsiness
D) Delusional accusations

Question 10

Which assessment findings would the nurse evaluate as indicating substance dependence? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The patient is exhibiting tolerance.
B) The patient spends significant amounts of time trying to obtain the substance.
C) The patient continues to use the substance after acknowledging it is not good for his health.
D) The patient describes several attempts to control substance use.
E) The patient continues to use the substance in spite of serious relationship problems.

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. How would the nurse evaluate this information?

A) The patient's biological parents might have abused alcohol.
B) The patient spends time drinking with friends.
C) Consuming alcohol is a symptom of stress.
D) Alcoholism is a learned behavior.

Question 12

A nurse frequently cannot be found on the unit when patients call for assistance. When colleagues mention these absences, the nurse becomes defensive and withdraws from the others. What does the nurse's behavior suggest?

A) Substance abuse
B) A long-standing illness
C) Introverted behavior
D) Low self-esteem

Question 13

A patient is exhibiting addictive behaviors and has admitted to using illegal drugs. Which statements by the patient are consistent with addictive behaviors? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "I think even as a child I didn't have much self-esteem."
B) "When I was in the hospital for appendicitis, they told me they had to give me more pain medication 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 14

A patient admitted with seizures is diagnosed with a perforated nasal septum. The nurse realizes that this patient most likely has abused which substance?

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

Question 15

A patient tells the nurse that both his parents are alcoholics, and he wonders about the likelihood of becoming an alcoholic as well. How should the nurse respond?

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 16

A community pharmacist calls the clinic and reports that a patient has asked for pain medication refills early for the last 2 months. What action should be taken by the nurse?

A) Notify the health care provider that the patient has lost control of his or her consumption of medication.
B) Tell the pharmacist to refill the prescriptions early.
C) Ask the pharmacist if the patient has received medications early from any other provider.
D) Notify the health care provider of the patient's request.

Question 17

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 2 hours prior to the accident. Which assessment findings are consistent with this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The apical heart rate is 112 beats per minute.
B) Premature ventricular 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) The patient's blood pressure is 96/72.

Question 18

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

A) Vitamin B₁
B) Warfarin
C) Methadone
D) Narcan

Question 19

A patient comes to the emergency department with a PCP overdose. Which intervention can the nurse anticipate the patient will require?

A) Administering a benzodiazepine as prescribed
B) Inducing vomiting
C) Assisting with lavage
D) Administering Narcan as prescribed

Question 20

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. How should the nurse respond?

A) "Have you considered seeking treatment for this behavior?"
B) "You must not have many friends left."
C) "Have your actions caused problems for you at work?"
D) "I don't see how that kind of behavior helps get you what you want."

Question 21

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

Question 22

The nurse realizes the patient is describing tolerance when the patient makes which statement?

A) "I think I have the flu. My stomach is upset and my hands are shaking."
B) "If I have my drink before I go home, I don't lose my patience so easily."
C) "I had a really good time at the party. At least my friends told me I did, but I don't remember much of it."
D) "I seem to need more alcohol each evening just to unwind."

Question 23

The nurse is assessing a patient who reports frequent use of marijuana during her current pregnancy. The nurse would teach the patient about which effects of this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Poor pregnancy outcomes
B) Bradycardia
C) Lung damage with long-term use
D) Diuresis
E) Increased risk of respiratory cancer

Question 24

A patient tells the nurse that he does not want to attend his wife's family events because he is expected to drink alcohol and he prefers not to. The nurse realizes this patient is describing behaviors found within which theory of substance disorders?

A) Sociocultural
B) Psychological
C) Biological
D) Metaphysical

Question 25

A patient tells the nurse that he gets off cocaine for a while and then in a few months finds himself "hanging out in the same places" where he knows he can easily get drugs. How should the nurse respond?

A) "This will happen for the rest of your life. There isn't anything you can do to change it."
B) "This is drug-seeking behavior and is a response to a craving. What can you do instead of going to the places where you can get drugs?"
C) "This is because you are an addict and need the drugs."
D) "Have you considered using a less addictive type of drug instead of the kind you used to use?"

Question 26

A young adult patient tells the nurse that he periodically uses "uppers" to keep awake while studying for college classes, so he does not understand why he has been feeling so depressed lately. How would the nurse interpret what the patient is experiencing?

A) Expected effects of the drug
B) Symptoms of a "crash"
C) Cocaine abstinence syndrome
D) Hallucinations

Question 27

A patient is admitted with symptoms of alcohol withdrawal. Which intervention is the highest priority for this patient?

A) Encourage verbalization of feelings.
B) Support respiratory and cardiac status.
C) Keep the room dimly lit.
D) Encourage taking fluids by mouth.

Question 28

The nurse should ask nonjudgmental questions when assessing a patient for substance abuse. Which questions would be appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: 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) "When you drink alcohol, do you usually drink a pint or a quart?"
D) "You don't drink hard liquor, do you?"
E) "Why in the world did you ever start abusing prescription drugs?"

Question 29

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

Question 30

A patient has been admitted to withdraw from alcohol. The patient is agitated and restless and complains of having "the shakes." The nurse anticipates this patient will experience these effects for at least _____ weeks.