Question 1

A young, unresponsive adult is brought to the emergency department by friends, who report, "He 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/minute; T, 96.8 $\degree$ F; and P, 76/minute and weak and thready. The provider will order which intervention to best minimize the patient's risk of renal failure?

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

Gastric lavage and dialysis

Accepted Answer

Gastric lavage and dialysis&#10;

Question 2

A college student is brought to the emergency department after collapsing at a nightclub. The patient has a temperature of 105 $\degree$ F, a clenched jaw, and confusion. Which medication will the provider prescribe?

A) Dantrolene
B) Haloperidol
C) Methadone
D) Naloxone

Dantrolene

Accepted Answer

Dantrolene is used to treat muscle rigidity and high fever associated with conditions like malignant hyperthermia and neuroleptic malignant syndrome, which can present with symptoms similar to those described.

Question 3

A young adult patient is admitted to the hospital for evaluation of severe weight loss. The patient demonstrates difficulty answering questions, and has trouble remembering simple details. The physical assessment reveals missing teeth and severe examples of tooth decay. Blood pressure is 160/98 mm Hg. The provider suspects abuse of which substance?

A) Cocaine
B) Ecstasy
C) Marijuana
D) Methamphetamine

Methamphetamine

Accepted Answer

Methamphetamine abuse can lead to severe dental problems, often referred to as "meth mouth," characterized by extensive tooth decay and tooth loss. It can also cause cognitive impairments and is associated with elevated blood pressure, matching the symptoms described.

Question 4

A patient who just found out she is pregnant requests pharmacologic aids to help her quit smoking. The provider will give her what information?&#10;A) &#34;Nicotine replacement therapy is not without its risks, but it is safer than smoking, so it can be used.&#34;&#10;B) &#34;Psychosocial support is the only recommended treatment for smoking cessation during pregnancy.&#34;&#10;C) &#34;Varenicline is known to be safer to use during pregnancy than nicotine products.&#34;&#10;D) &#34;You should try to taper off your smoking gradually, because none of the drugs to assist with smoking cessation are safe.&#34;

Accepted Answer

Nicotine replacement therapy (NRT) is considered safer than continuing to smoke during pregnancy because smoking can lead to several adverse outcomes for both the mother and the fetus, including low birth weight, preterm birth, and increased risk of sudden infant death syndrome (SIDS). While NRT does carry risks, the benefits of quitting smoking with its aid generally outweigh the potential risks associated with its use during pregnancy.

Question 5

A patient who has a long-term addiction to opioids is believed to have taken an overdose of barbiturates. The provider will anticipate which likely outcome?&#10;A) Severe abstinence syndrome when the effects of the barbiturates are reversed&#10;B) Minimal respiratory depression, because the patient has developed a tolerance to opioids&#10;C) Pinpoint pupils, respiratory depression, and possibly coma&#10;D) Paradoxical excitation resulting from a drug-drug interaction

Accepted Answer

Barbiturate overdose typically results in symptoms such as pinpoint pupils, respiratory depression, and possibly coma, regardless of opioid tolerance.

Question 6

A patient who wants to quit smoking has been taking varenicline. The patient calls the clinic to report a new onset of mood swings and depression with a desire to cause self-harm. What response will the provider give to this patient?

A) "These symptoms are common and will disappear over time."
B) "These symptoms may indicate an underlying psychiatric disorder."
C) "You may need an increased dose to overcome these symptoms of nicotine withdrawal."
D) "Go to the emergency room immediately."

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Accepted Answer

Varenicline can cause mood swings, depression, and thoughts of self-harm as side effects. These symptoms are serious and warrant immediate medical attention, hence the advice to go to the emergency room.

Question 7

A patient with opioid use disorder has undergone detoxification with buprenorphine. Afterward, the provider prescribes buprenorphine and naloxone. When the patient asks why the drug was changed, what response will the prescriber provide?

A) "This combination has a lower risk of abuse."
B) "It has a longer half-life."
C) "Buprenorphine causes more respiratory depression."
D) "The combination drug contains more buprenorphine."

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Accepted Answer

The combination of buprenorphine and naloxone is used to lower the risk of misuse or abuse. Naloxone is an opioid antagonist that is inactive when taken orally as prescribed but will induce withdrawal symptoms if the combination is injected, thus deterring misuse.

Question 8

The provider is discussing the management of prescribed, controlled substances with a patient. Which statement by the patient indicates understanding of the information provided?&#10;A) &#34;If there is a difference between state and federal laws governing a scheduled drug, the federal law takes precedence.&#34;&#10;B) &#34;Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills.&#34;&#10;C) &#34;Schedule I drugs may only be given to hospitalized patients.&#34;&#10;D) &#34;To reduce the possibility of abuse of a drug that is Schedule II, the prescriber should call the prescription to the pharmacy.&#34;

Accepted Answer

Prescriptions for drugs in Schedules III and IV may be written to include up to 5 refills within a 6-month period, which aligns with federal regulations.

Question 9

A patient with opioid use disorder seeks treatment. When discussing the rationale for using methadone to ease opioid withdrawal, the provider explains that methadone has which pharmacologic property or characteristic?

A) It can prevent abstinence syndrome.
B) It has a shorter duration of action than other opioids.
C) It is a nonopioid agent.
D) It lacks cross-tolerance with other opioids.

Accepted Answer

Methadone is a long-acting opioid agonist that can prevent abstinence syndrome (withdrawal symptoms) in patients with opioid use disorder by acting on the same opioid receptors as other opioids, but with a slower onset and longer duration of action, allowing for a more controlled and gradual reduction of opioid dependence.

Question 10

A 4-year-old child who ingested several cigarettes at home presents to the emergency department with nausea and vomiting and a weak, thready pulse of 120 beats/minute. What intervention will the provider order?

A) Gastric lavage
B) Hemodialysis
C) Respiratory support
D) Vasoconstrictors

Accepted Answer

Respiratory support is the most appropriate intervention in this scenario because nicotine poisoning, which is likely given the ingestion of several cigarettes, can cause respiratory failure. The symptoms of nausea, vomiting, and a weak, thready pulse indicate nicotine toxicity, and ensuring the child can breathe adequately is a priority.

Question 11

A patient's admission history confirms a habit of daily drinking for several years. When questioned further by the provider, the patient reports drinking up to five or six drinks each day. What action will the provider prioritize?

A) Ordering a liver function study
B) Explaining that hepatitis, progressing to severe liver impairment, is likely
C) Informing the patient that the history indicates that cirrhosis is likely to occur
D) Telling the patient that to stop drinking now will likely reverse any effects on the liver

Accepted Answer

The answer of A patient's admission history confirms a habit...

Question 12

What is the provider's ideal goal of drug rehabilitation?&#10;A) Abstinence from the drug&#10;B) Decreasing episodes of relapse&#10;C) Minimizing drug cravings&#10;D) Reduction of drug use

Accepted Answer

The answer of What is the provider's ideal goal of...

Question 13

A patient with alcohol abuse disorder is admitted to the hospital for surgery. The provider is most concerned when the admission interview determines the patient regularly used what medication?&#10;A) Acetaminophen&#10;B) Diazepam&#10;C) Morphine&#10;D) Thiamine

Accepted Answer

The answer of A patient with alcohol abuse disorder is...

Question 14

A patient with a desire to stop smoking asks a provider about nicotine chewing gum. The patient currently smokes 30 cigarettes per day. What instructions will the provider give the patient?&#10;A) &#34;You will need to use the gum for 6 months after you stop using cigarettes.&#34;&#10;B) &#34;Use the 4-mg strength gum and chew one piece every 2 to 3 hours.&#34;&#10;C) &#34;Use the gum whenever you feel a craving for a cigarette.&#34;&#10;D) &#34;You should start with 30 pieces of the 2-mg strength gum per day.&#34;

Accepted Answer

The answer of A patient with a desire to stop...

Question 15

A patient reports a desire to stop smoking and asks about nonprescription aids to help with smoking cessation. What intervention will the provider recommend for this patient?&#10;A) Select a day to quit and stop completely to shorten withdrawal effects.&#10;B) Start a nicotine replacement product and call 1-800-QUITNOW.&#10;C) Take nicotine replacement products for one year and then taper off the product.&#10;D) Taper off nicotine while beginning and tapering up benzodiazepine therapy.

Accepted Answer

The answer of A patient reports a desire to stop...

Question 16

A patient who is agitated, paranoid, and profoundly anxious is brought to the emergency department. The patient describes things in the room that do not exist. A cardiac monitor shows an irregular ventricular tachycardia. Which medication will the provider order to be administer?

A) Anticocaine vaccine
B) Diazepam
C) Disulfiram
D) Vigabatrin

Accepted Answer

The answer of A patient who is agitated, paranoid, and...

Question 17

A provider, prescribing pain medication to each patient, will be most concerned about which patient developing a substance use disorder?&#10;A) A college student with migraine headaches who reports having experimented with marijuana in the past year.&#10;B) An older adult patient with terminal cancer who requires twice the normal dose of morphine for pain relief.&#10;C) A patient in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due.&#10;D) A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain.

Accepted Answer

The answer of A provider, prescribing pain medication to each...

Question 18

A patient who arrives in the emergency department is difficult to arouse. The patient's friends volunteer that the patient took a handful of diazepam pills while at a party several hours ago. The provider will prescribe what medication to be administered?

A) Buprenorphine
B) Flumazenil
C) Nalmefene
D) Naloxone

Accepted Answer

The answer of A patient who arrives in the emergency...

Question 19

A pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider?&#10;A) Determining how much alcohol she consumed, and at which stage of her pregnancy&#10;B) Ordering a blood alcohol serum level test&#10;C) Telling the patient that no amount of alcohol is considered safe during pregnancy&#10;D) Telling the patient that the full range of outcomes may not be evident for years

Accepted Answer

The answer of A pregnant patient is afraid she may...

Question 20

A patient with decreased responsiveness arrives by ambulance following a night of binge-drinking. The patient exhibits slurred speech and hand tremors. After receiving reports that the patient's blood alcohol level is 0.4%, the provider begins preparation for what event?

A) The patient's imminent loss of consciousness
B) Administration of naltrexone and preparation for gastric lavage
C) Prescribing carbamazepine STAT to reduce the risk of seizures
D) Providing mechanical ventilation and oxygen to manage respiratory depression

Accepted Answer

The answer of A patient with decreased responsiveness arrives by...

Deck 8: Substance Use Disorders