Question 1

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 2

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 3

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

In moderate amounts, alcohol helps preserve cognitive function in the older adult and may protect against dementia. Alcohol disrupts sleep and alters sleep cycles, reducing total sleeping time and the quality of sleep. Alcohol lowers inhibitions but diminishes sexual responsiveness. Alcohol dilates cutaneous blood vessels, which actually promotes heat loss.

Question 4

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

Acetaminophen poses a risk of fatal liver damage in alcoholics, because evidence indicates that even modest alcohol consumption combined with acetaminophen has this effect. Diazepam would probably be useful in this case, because it is used to aid alcohol withdrawal. However, diazepam cannot be taken with alcohol, because the central nervous system (CNS) depressive effects would be compounded. Likewise, morphine is safe as long as it is not given with alcohol. Thiamine is a vitamin that often is deficient in alcoholics, so thiamine would be indicated.

Question 5

A nursing student asks a nurse about the effects of alcohol on the heart. Which statement by the nurse is correct?&#10;A) &#34;Alcohol produces a dose-dependent decrease in blood pressure.&#34;&#10;B) &#34;It is better to consume moderate amounts 1 or 2 days per week than 3 or 4 days per week.&#34;&#10;C) &#34;Moderate consumption of alcohol protects the heart by elevating low-density lipoproteins.&#34;&#10;D) &#34;Moderate amounts of alcohol may inhibit the development of atherosclerosis.&#34;

Accepted Answer

Moderate amounts of alcohol help minimize clot formation and clot destruction and also help suppress the inflammatory component of atherosclerosis. Alcohol produces a dose-dependent increase in blood pressure. For moderate drinkers, consumption 3 or 4 days per week is better than 1 to 2 days per week to obtain cardiovascular benefits. Moderate consumption of alcohol elevates high-density lipoproteins.

Question 6

A college student is brought unresponsive 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 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

A blood alcohol level that exceeds 0.4% poses a substantial risk of respiratory depression. Patients who are chronic abusers of alcohol may develop tolerance to other effects of increased blood levels, such as sedation, or behavioral changes, but there is very little tolerance to respiratory depression. A patient with a blood alcohol level of 0.4% must be treated for respiratory depression, usually with mechanical ventilation. If this patient has developed tolerance, which is likely because loss of consciousness has not already occurred, the nurse cannot expect that the patient will lose consciousness. Naltrexone is not used for acute toxicity. Carbamazepine is used as an adjunct to benzodiazepines and may be used after this patient's immediate needs have been addressed.

Question 8

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

Chronic use of alcohol can produce severe neurologic and psychiatric disorders. This patient shows signs of Wernicke's encephalopathy, which is readily reversible with thiamine. With proper nutrition, the symptoms will clear completely. Korsakoff's psychosis is not reversible; signs of this disorder include polyneuropathy, memory disorders, and confabulation. Wernicke's encephalopathy requires thiamine supplementation and not just detoxification, which is treatment to withdraw alcohol from the patient's system.

Question 9

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 10

A male patient tells a nurse that he drinks a six pack 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."

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Accepted Answer

The amount of alcohol in one can of beer is equivalent to the amount in a shot of whiskey or one 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 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 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 a six pack 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

The answer of A nurse is screening a patient being...

Question 13

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;Moderate consumption 3 or 4 days each week is the best way to prevent heart disease.&#34;

Accepted Answer

The answer of A patient tells a nurse that she...

Question 14

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

The answer of A patient asks a nurse about the...

Question 15

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)

Accepted Answer

The answer of A patient who has undergone treatment for...

Deck 38: Drug Abuse 2: F Alcohol