Deck 18: Addictive Disorders

Question 1

Select the most accurate description of substance dependence.

A) Symptoms occur when two or more drugs affecting the central nervous system are used for their additive effects.
B) Lack of control over use.Tolerance exists.Withdrawal symptoms occur when intake is reduced or stopped.
C) Psychoactive drug use interferes with the action of competing neurotransmitters.
D) Taking a combination of drugs to weaken or inhibit the effect of another drug.

Answer 1

Lack of control over use.Tolerance exists.Withdrawal symptoms occur when intake is reduced or stopped.

Question 2

When a patient first began using alcohol,two drinks produced relaxation and drowsiness.After 1 year,four drinks are needed to achieve the same response.Why has this change occurred?

A) The alcohol is less potent.
B) Tolerance has developed.
C) Hypomagnesemia has occurred.
D) Antagonistic effects are evident.

Answer 2

Tolerance has developed.

Question 3

A nurse reviews vital signs for a patient admitted last night with an injury sustained while intoxicated.The medical record shows these blood pressure and pulse readings:
Admission,2 AM - 118/78 mm Hg and 72 beats/min
4 AM - 126/80 mm Hg and 76 beats/min
6 AM - 128/82 mm Hg and 72 beats/min
8 AM - 132/88 mm Hg and 80 beats/min
10 AM - 148/94 mm Hg and 96 beats/min
What is the nurse's priority action?

A) Force fluids.
B) Consult the health care provider.
C) Obtain a clean-catch urine sample.
D) Place the patient in a vest-type restraint.

Answer 3

Consult the health care provider.

Question 4

An attractive nurse worked at a community hospital for several months,resigned,then took a position at another hospital.In the new position,the nurse volunteered to be the medication nurse.Several serious medication errors occurred in rapid succession.Investigation uncovered that the nurse was allowed to resign from the community hospital after diverting patient narcotics for own use.The nurse manager retrospectively identified which early indicator of the nurse's drug use? The nurse:

A) sought to be assigned as medication nurse.
B) cooperated with the investigation.
C) presented a neat appearance.
D) was sociable with peers.

Question 5

During the third week of treatment,the spouse of a patient in an alcoholism rehabilitation program says,"After this treatment program,I think everything will be all right." Which remark by the nurse will be most helpful to the spouse?

A) "It is good that you're supportive of your spouse's sobriety and want to help maintain it."
B) "While sobriety solves some problems,new ones may emerge as one adjusts to living without alcohol."
C) "It will be important for you to structure life to avoid as much stress as you can.You will need to provide social protection."
D) "Alcohol is a lifelong disease of self-destruction.You will need to observe your spouse's behavior carefully."

Question 6

A patient asks for information about Alcoholics Anonymous.Select the nurse's best response."Alcoholics Anonymous is a:

A) form of group therapy led by a psychiatrist."
B) self-help group for which the goal is sobriety."
C) group that learns about drinking from a group leader."
D) network that advocates strong punishment for drunk drivers."

Question 7

An alcohol-dependent patient was hospitalized at 4 AM on Saturday.The patient's last drink was at 2 AM.When would the nurse expect withdrawal symptoms to peak then disappear or progress to delirium?

A) Between 8 AM and 10 AM Saturday
B) Between 10 AM and 4 PM Saturday
C) Between 4 PM Saturday and 4 AM Sunday
D) Between 2 AM Sunday and 2 AM Monday

Question 8

Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol dependence.

A) Strongly confrontational
B) Empathetic,supportive
C) Skeptical,guarded
D) Cool,distant

Question 9

Which medication to maintain abstinence would most likely be prescribed for patients with either alcoholism or opioid addiction?

A) Bromocriptine (Parlodel)
B) Methadone (Dolophine)
C) Disulfiram (Antabuse)
D) Naltrexone (ReVia)

Question 10

A patient was admitted last night with a hip fracture sustained while intoxicated.The patient points to the Buck's traction and screams,"Why did you tie me up? Please let me go." The patient is experiencing:

A) a delusion.
B) an illusion.
C) hallucinations.
D) codependence.

Question 11

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours.The patient is now shaky,irritable,anxious,diaphoretic,and reports nightmares.The pulse rate is 130 beats/min.The patient shouts,"Bugs are crawling on my bed.I've got to get out of here." Select the most accurate assessment of this situation.The patient:

A) is attempting to obtain attention by manipulating staff.
B) may have sustained a head injury before admission.
C) has symptoms of alcohol-withdrawal delirium.
D) is having an acute psychosis.

Question 12

Police bring a patient to the emergency department after an automobile accident.The patient is ataxic and has slurred speech and mild confusion.The blood alcohol level is 0.4 mg%.Considering the relationship between the behavior and blood alcohol level,which conclusion is most probable? The patient:

A) rarely drinks alcohol.
B) has a high tolerance to alcohol.
C) has been treated with disulfiram (Antabuse).
D) has ingested both alcohol and sedative drugs recently.

Question 13

When a patient comes to an outpatient appointment,a nurse smells alcohol.The nurse should:

A) explore the patient's reasons for drinking today.
B) arrange admission to an inpatient psychiatric unit.
C) coordinate emergency admission to a detoxification unit.
D) tell the patient,"We cannot see you today because you have been drinking."

Question 14

The treatment team discusses a patient diagnosed with paranoid schizophrenia and cannabis abuse who is having increased hallucinations and delusions.The patient has recently used cannabis on a daily basis.To plan effective treatment,the team should:

A) provide long-term care for the patient in a residential facility.
B) withdraw the patient from cannabis,then treat the schizophrenia.
C) consider each diagnosis primary,and provide simultaneous treatment.
D) first treat the schizophrenia,then establish goals for substance abuse treatment.

Question 15

An alcohol dependent patient says,"Drinking helps me cope with being a single parent." Which response by the nurse would help the patient conceptualize the drinking more objectively?

A) "Sooner or later,alcohol will kill you.Then what will happen to your children?"
B) "I hear a lot of defensiveness in your voice.Do you really believe this?"
C) "If you were coping so well,why were you hospitalized again?"
D) "Tell me what happened the last time you drank."

Question 16

In the emergency department,a patient's vital signs are: BP 66/40 mm Hg;pulse 140 beats/min;respirations 8 breaths/min and shallow.The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic overdose.Select the priority outcome.

A) Within 4 hours,vital signs will stabilize,with BP above 90/60 mm Hg,pulse less than 100 beats/min,and respirations at or above 12 breaths/min.
B) The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department.
C) Within 6 hours,the patient's breath sounds will be clear bilaterally and throughout lung fields.
D) The patient will demonstrate effective coping skills within 1 week of hospitalization.
E) The patient will identify community resources for treatment of substance abuse.

Question 17

A patient admitted to an alcoholism rehabilitation program tells the nurse,"I'm actually a social drinker.I usually have one drink at lunch,two cocktails in the afternoon,wine with dinner,and a few drinks during the evening." Which defense mechanism is evident?

A) Denial
B) Projection
C) Introjection
D) Rationalization

Question 18

A hospitalized,alcohol-dependent patient believes spiders are spinning entrapping webs in the room.The patient is fearful,agitated,and diaphoretic.Which nursing intervention is indicated?

A) Check the patient every 15 minutes.
B) One-on-one supervision.
C) Keep the room dimly lit.
D) Force fluids.

Question 19

A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed.The patient is anxious,agitated,and diaphoretic.What is the priority nursing diagnosis?

A) Ineffective airway clearance
B) Ineffective coping
C) Ineffective denial
D) Risk for injury

Question 20

An alcohol-dependent patient admitted yesterday believes the window blinds are snakes trying to get in the room.The patient is anxious,agitated,and diaphoretic.The nurse can anticipate the health care provider will prescribe a:

A) benzodiazepine,such as lorazepam (Ativan)or chlordiazepoxide (Librium).
B) antipsychotic,such as olanzapine (Zyprexa)or thioridazine (Mellaril).
C) monoamine oxidase inhibitor,such as phenelzine (Nardil).
D) narcotic analgesic,such as codeine.

Question 21

Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.

A) Monitor vital signs.
B) Observe for depression.
C) Use warmers to maintain body temperature.
D) Offer intellectual activities to stimulate concentration.

Question 22

A new patient beginning an alcoholism rehabilitation program says,"I'm just a social drinker.I usually have one drink at lunch,two in the afternoon,wine at dinner,and a few drinks during the evening." Select the nurse's most therapeutic responses.Select all that apply.

A) "I see," and use interested silence.
B) "I think you are drinking more than you report."
C) "Social drinkers have one or two drinks,once or twice a week."
D) "You describe drinking steadily throughout the day and evening."
E) "Your comments show denial of the seriousness of your problem."

Question 23

A patient is comatose after ingesting six codeine tablets.The patient's friend says,"Often my friend drinks along with taking more of the drug than is prescribed." Use of alcohol with this drug:

A) has a synergistic effect.
B) diminishes the drug's effect.
C) causes no effect.
D) stimulates metabolism of the drug.

Question 24

A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse.Which is the nurse's best first action?

A) Perform a thorough assessment of the patient.
B) Verify that security services are immediately available.
C) Self-assess personal attitude,values,and beliefs about this health problem.
D) Obtain a face shield.Oral hygiene is poor in methamphetamine abusers.

Question 25

Select the priority outcome for a patient completing the fourth alcohol-detoxification program in 1 year.Prior to discharge,the patient will:

A) state,"I know I need long-term treatment."
B) use denial and rationalization in healthier ways.
C) identify constructive outlets for expression of anger.
D) develop a trusting relationship with one staff member.

Question 26

A patient with antisocial behavior was treated several times for substance dependence.Each time,the patient relapsed.Which treatment approach is most appropriate?

A) 1-week detoxification program
B) Long-term outpatient therapy
C) 12-step self-help program
D) Residential program

Question 27

Which assessment findings are likely for an individual who recently injected heroin?

A) Anxiety,restlessness,paranoid delusions
B) Muscle aching,dilated pupils,tachycardia
C) Heightened sexuality,insomnia,euphoria
D) Drowsiness,constricted pupils,slurred speech

Question 28

A patient has smoked two packs of cigarettes daily for many years.When the patient tries to reduce smoking,he experiences anxiety,craving,poor concentration,and headache.This scenario describes:

A) substance abuse.
B) substance dependence.
C) substance intoxication.
D) recreational use of a social drug.

Question 29

An adult in the emergency department states,"Everything I see waves.I am outside my body looking at myself.I think I'm losing my mind." Vital signs are slightly elevated.The nurse should suspect:

A) a schizophrenic episode.
B) opium intoxication.
C) cocaine overdose.
D) LSD ingestion.

Question 30

A patient is thin,tense,jittery,and has dilated pupils.The patient says,"I'm burning up.I need help." The patient allows a temperature to be taken (it is 104° F),then becomes suspicious and says,"You could be trying to kill me." The patient refuses further examination.Abuse of which substance is most likely?

A) PCP
B) Heroin
C) Barbiturates
D) Amphetamines

Question 31

A patient overdosed on methamphetamine.Priority nursing and medical measures include: (Select all that apply. )

A) administration of naloxone (Narcan).
B) vitamin B12 and folate supplements.
C) restoring nutritional integrity.
D) reduction of fever.
E) prevention of seizures.

Question 32

Symptoms of withdrawal from central nervous system depressants for which the nurse should assess include:

A) dilated pupils,tachycardia,elevated blood pressure,elation.
B) mood lability,incoordination,fever,drowsiness.
C) nausea,vomiting,diaphoresis,anxiety,tremors.
D) excessive eating,constipation,headache.

Question 33

A nurse with a history of narcotic abuse became unconscious in the locker room after overdosing.After stabilization,the nurse was transferred to the inpatient psychiatric unit.Which action by nursing staff may be enabling?

A) Empathizing when the nurse discusses fears of disciplinary action by the state board of nursing.
B) Pointing out that work problems are the result,not the cause,of substance abuse.
C) Conveying understanding that pressures associated with nursing practice cause substance abuse.
D) Providing health teaching about stress management.

Question 34

The nurse can assist a patient to prevent substance abuse relapse by: (Select all that apply. )

A) rehearsing techniques to handle anticipated stressful situations.
B) advising the patient to accept residential treatment if relapse occurs.
C) assisting the patient to identify life skills needed for effective coping.
D) advising isolation from significant others and social situations until sobriety is established.
E) informing the patient of physical changes to expect as the body adapts to functioning without substances.

Question 35

When assessing a patient who ingested flunitrazepam (Rohypnol),the nurse would expect:

A) acrophobia.
B) hypothermia.
C) hallucinations.
D) anterograde amnesia.