Deck 19: Substance-Related and Addictive Disorders

Question 1

A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, "Snakes are crawling on my bed. I've got to get out of here." What is the most accurate assessment of the 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 a recurrence of an acute psychosis.

Answer 1

has symptoms of alcohol withdrawal delirium.

Question 2

Which statement most accurately describes substance addiction?

A) A chronic, relapsing brain disease associated with craving and a lack of control over use of a substance.
B) A disorder associated with tolerance to a substance as well as withdrawal symptoms if use is abruptly discontinued.
C) Behaviors associated with habitual use of a substance for the single purpose of altering one's mood, emotion, or state of consciousness.
D) A behavioral disorder associated with selected personality features.

Answer 2

A chronic, relapsing brain disease associated with craving and a lack of control over use of a substance.

Question 3

The treatment team plans care for a person diagnosed with schizophrenia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning?

A) Consider each disorder primary and provide simultaneous treatment.
B) The person will benefit from treatment in a residential treatment facility.
C) Withdraw the person from cannabis, and then treat the schizophrenia.
D) Treat the schizophrenia first, and then establish the goals for the treatment of substance abuse.

Answer 3

Consider each disorder primary and provide simultaneous treatment.

Question 4

When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After 1 year of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?

A) Tolerance develops
B) The alcohol is less potent
C) Antagonistic effects occur
D) Hypomagnesemia develops

Question 5

A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?

A) Monoamine oxidase inhibitor, such as phenelzine (Nardil)
B) Phenothiazine, such as thioridazine (Mellaril)
C) Benzodiazepine, such as lorazepam (Ativan)
D) Narcotic analgesic, such as morphine

Question 6

Police bring a patient to the emergency department after an automobile accident. The patient is ataxic with slurred speech and mild confusion. The blood alcohol level is 400 mg/dl (0.40 mg %). Considering the relationship between behavior and blood alcohol level, which conclusion can the nurse draw? The patient:

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

Question 7

A patient comes to an outpatient appointment obviously intoxicated. 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've been drinking."

Question 8

A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?

A) Between 0800 and 1000 today (6 to 8 hours after drinking stopped)
B) Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)
C) About 0200 on hospital day 3 (72 hours after drinking stopped)
D) About 0200 on hospital day 4 (96 hours after drinking stopped)

Question 9

In the emergency department, a patient's vital signs are: blood pressure (BP), 66/40 mm Hg; pulse (P), 140 beats per minute (bpm); and respirations (R), 8 breaths per minute and shallow. The patient overdosed on illegally obtained hydromorphone (Dilaudid). Select the priority outcome.

A) Within 8 hours, vital signs will stabilize as evidenced by BP greater than 90/60 mm Hg, P less than 100 bpm, and respirations at or above 12 breaths per minute.
B) The patient will be able to describe a plan for home care and achieve a drug-free state before being released from the emergency department.
C) The patient will attend daily meetings of Narcotics Anonymous within 1 week of beginning treatment.
D) The patient will identify two community resources for the treatment of substance abuse by discharge.

Question 10

When working with a patient beginning treatment for alcohol abuse, what is the nurse's most therapeutic approach?

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

Question 11

A patient admitted for a heroin overdose received naloxone (Narcan). The patient's breathing pattern improved. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, "I feel terrible." Which analysis is correct?

A) The patient is exhibiting a prodromal symptom of seizures.
B) An idiosyncratic reaction to naloxone is occurring.
C) Symptoms of opiate withdrawal are present.
D) The patient is experiencing a relapse.

Question 12

A new patient in an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and a few drinks in the evening." Which response by the nurse will help the patient view the drinking more honestly?

A) "I see," and use interested silence.
B) "I think you may be drinking more than you report."
C) "Being a social drinker involves having a drink or two once or twice a week."
D) "You describe drinking steadily throughout the day and evening. Am I correct?"

Question 13

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

A) Disturbed sensory perception
B) Ineffective coping
C) Ineffective denial
D) Risk for injury

Question 14

A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is:

A) jaundiced.
B) dependent on alcohol.
C) healthy but underweight.
D) microcephalic and cognitively impaired.

Question 15

A patient with a history of daily alcohol use says, "Drinking helps me cope with being a single parent." Which response by the nurse would help the individual 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

During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, "After discharge, I think everything will be just fine." 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) "Although 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 possible. You will need to provide social protection."
D) "Remember that alcoholism is a disorder of self-destruction. You will need to observe your spouse's behavior carefully."

Question 17

A patient asks for information about Alcoholics Anonymous (AA). Which is the nurse's best response?

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

Question 18

A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?

A) Check the patient every 15 minutes.
B) Rigorously encourage fluid intake.
C) Provide one-on-one supervision.
D) Keep the room dimly lit.

Question 19

A patient admitted to an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and several drinks during the evening." The patient is using which defense mechanism?

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

Question 20

A patient was admitted one day ago with a hip fracture sustained in a fall while intoxicated. The patient points to the Buck's traction and screams, "Somebody tied me up with ropes." The patient is experiencing:

A) an illusion.
B) a delusion.
C) hallucinations.
D) hypnagogic phenomenon.

Question 21

A patient in an alcohol treatment program says, "I have been a loser all my life. I'm so ashamed of what I have put my family through. Now, I'm not even sure I can succeed at staying sober." Which nursing diagnosis applies?

A) Chronic low self-esteem
B) Situational low self-esteem
C) Disturbed personal identity
D) Ineffective health maintenance

Question 22

Select the nursing intervention necessary after administering naloxone (Narcan) to a patient experiencing an opiate overdose.

A) Monitor the airway and vital signs every 15 minutes.
B) Insert a nasogastric tube and test gastric pH.
C) Treat hyperpyrexia with cooling measures.
D) Insert an indwelling urinary catheter.

Question 23

Which medication is the nurse most likely to see prescribed as part of the treatment plan for both a patient in an alcoholism treatment program and a patient in a program for the treatment of opioid addiction?

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

Question 24

Which documentation indicates that the treatment plan for a patient in an alcohol treatment program was effective?

A) Is abstinent for 10 days and states, "I can maintain sobriety one day at a time." Spoke with employer, who is willing to allow the patient to return to work in 3 weeks.
B) Is abstinent for 15 days and states, "My problems are under control." Plans to seek a new job where coworkers will not know history.
C) Attends AA daily; states many of the members are "real" alcoholics and says, "I may be able to help some of them find jobs at my company."
D) Is abstinent for 21 days and says, "I know I can't handle more than one or two drinks in a social setting."

Question 25

Select the most appropriate outcome for a patient completing the fourth alcohol detoxification program in 1 year. Before discharge, the patient will

A) use rationalization in healthy ways.
B) state, "I see the need for ongoing treatment."
C) identify constructive outlets for expression of anger.
D) develop a trusting relationship with one staff member.

Question 26

Which question has the highest priority when assessing a newly admitted patient with a history of alcohol abuse?

A) "Have you ever had blackouts?"
B) "When did you have your last drink?"
C) "Has drinking caused you any problems?"
D) "When did you decide to seek treatment?"

Question 27

An adult in the emergency department states, "I feel restless. Everything I look at wavers. Sometimes I'm outside my body looking at myself. I hear colors. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect a:

A) cocaine overdose.
B) schizophrenic episode.
C) phencyclidine (PCP) intoxication.
D) D-lysergic acid diethylamide (LSD) ingestion.

Question 28

Which assessment findings best correlate to the withdrawal from central nervous system depressants?

A) Dilated pupils, tachycardia, elevated blood pressure, elation
B) Labile mood, lack of coordination, fever, drowsiness
C) Nausea, vomiting, diaphoresis, anxiety, tremors
D) Excessive eating, constipation, headache

Question 29

A patient has smoked two packs of cigarettes daily for many years. When the patient does not smoke or tries to cut back, anxiety, craving, poor concentration, and headache result. What does this scenario describe?

A) Substance abuse
B) Substance addiction
C) Substance intoxication
D) Recreational use of a social drug

Question 30

A patient is admitted in a comatose state after ingesting five capsules of lorazepam. A friend of the patient says, "Often my friend drinks, along with taking more of the drug than is prescribed." What is the effect of the use of alcohol with this drug?

A) The drug's metabolism is stimulated.
B) The drug's effect is diminished.
C) A synergistic effect occurs.
D) There is no effect.

Question 31

Which is an important nursing intervention when giving care to a patient withdrawing from a central nervous system (CNS) stimulant?

A) Make physical contact by frequently touching the patient.
B) Offer intellectual activities requiring concentration.
C) Avoid manipulation by denying the patient's requests.
D) Observe for depression and suicidal ideation.

Question 32

A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled "lorazepam." What is the nurse's first action?

A) Test reflexes
B) Check pupils
C) Initiate vomiting
D) Establish a patent airway

Question 33

A nurse with a history of narcotic abuse is found unconscious in the hospital locker room after overdosing. The nurse is transferred to an inpatient substance abuse unit for care. Which attitudes or behaviors by nursing staff may be enabling?

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

Question 34

In what significant ways is the therapeutic environment different for a patient who has ingested D-lysergic acid diethylamide (LSD) than for a patient who has ingested phencyclidine (PCP)?

A) For LSD ingestion, one person stays with the patient and provides verbal support. For PCP ingestion, a regimen of limited contact with staff members is maintained, and continual visual monitoring is provided.
B) For PCP ingestion, the patient is placed on one-on-one intensive supervision. For LSD ingestion, a regimen of limited interaction and minimal verbal stimulation is maintained.
C) For LSD ingestion, continual moderate sensory stimulation is provided. For PCP ingestion, continual high-level stimulation is provided.
D) For LSD ingestion, the patient is placed in restraints. For PCP ingestion, seizure precautions are implemented.

Question 35

A nurse worked at a hospital for several months, resigned, and then took a position at another hospital. In the new position, the nurse often volunteers to be the medication nurse. After several serious medication errors, an investigation reveals that the nurse was diverting patient narcotics for self-use. What early indicator of the nurse's drug use was evident?

A) Accepting responsibility for medication errors.
B) Seeking to be assigned as a medication nurse.
C) Frequent complaints of physical pain.
D) High sociability with peers.

Question 36

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

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

Question 37

Which nursing diagnosis would likely apply both to a patient diagnosed with schizophrenia as well as a patient diagnosed with amphetamine-induced psychosis?

A) Powerlessness
B) Disturbed thought processes
C) Ineffective thermoregulation
D) Impaired oral mucous membrane

Question 38

Which treatment approach is most appropriate for a patient with antisocial tendencies who has been treated several times for substance addiction but has relapsed?

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

Question 39

Which assessment findings will the nurse expect in an individual who has just injected heroin?

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

Question 40

A newly hospitalized patient has needle tracks on both arms. A friend states that the patient uses heroin daily but has not used in the past 24 hours. The nurse should assess the patient for:

A) slurred speech, excessive drowsiness, and bradycardia.
B) paranoid delusions, tactile hallucinations, and panic.
C) runny nose, yawning, insomnia, and chills.
D) anxiety, agitation, and aggression.

Question 41

While caring for a patient with a methamphetamine overdose, which tasks are the priorities of care? (Select all that apply.)

A) Administration of naloxone (Narcan)
B) Vitamin B₁₂ and folate supplements
C) Restoring nutritional integrity
D) Prevention of seizures
E) Reduction of fever

Question 42

A patient undergoing alcohol rehabilitation decides to accept disulfiram (Antabuse) therapy to avoid impulsively responding to drinking cues. Which information should be included in the discharge teaching for this patient? (Select all that apply.)

A) Avoid aged cheeses.
B) Read labels of all liquid medications.
C) Wear sunscreen and avoid bright sunlight.
D) Maintain an adequate dietary intake of sodium.
E) Avoid breathing fumes of paints, stains, and stripping compounds.

Question 43

A nurse can assist a patient diagnosed with addiction and the patient's family in which aspects of relapse prevention? (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) Isolating self from significant others and social situations until sobriety is established
E) Teaching the patient about the physical changes to expect as the body adapts to functioning without substances

Question 44

Which assessment findings support a nurse's suspicion that a patient has been using inhalants?

A) Pinpoint pupils and respiratory rate of 12 breaths per minute
B) Perforated nasal septum and hypertension
C) Drowsiness, euphoria, and constipation
D) Confusion, mouth ulcers, and ataxia