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?

Accepted Answer

C

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

Accepted Answer

Ordering a liver function study is a priority to assess the current state of the liver and potential damage due to alcohol consumption.

Question 12

What is the provider's ideal goal of drug rehabilitation?

Accepted Answer

Abstinence from the drug is the provider's ideal goal of drug rehabilitation because it is the only way to ensure that the person will not experience any negative consequences from drug use.

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?

Accepted Answer

Acetaminophen (Tylenol) is metabolized by the liver and can cause liver damage, especially in combination with alcohol abuse, which also damages the liver. This increases the risk of severe liver injury.

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?

Accepted Answer

For a patient who smokes 30 cigarettes per day, using the 4-mg strength gum and chewing one piece every 2 to 3 hours is appropriate to manage withdrawal symptoms and cravings effectively.

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?

Accepted Answer

Nicotine replacement products are available over-the-counter and can help manage withdrawal symptoms. Calling 1-800-QUITNOW provides access to support and resources for smoking cessation.

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?

Accepted Answer

Diazepam is used in this scenario because it can help manage the acute agitation, paranoia, and anxiety the patient is experiencing, likely due to cocaine intoxication or withdrawal. Diazepam, a benzodiazepine, can also have a stabilizing effect on the heart rhythm, which is beneficial given the patient's irregular ventricular tachycardia. The other options do not directly address the acute symptoms presented.

Question 17

A provider, prescribing pain medication to each patient, will be most concerned about which patient developing a substance use disorder?

Accepted Answer

The patient with a history of using prescription narcotic analgesics for pain management is at a higher risk for developing a substance use disorder due to previous exposure and potential dependence on these medications.

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?

Accepted Answer

Flumazenil is a benzodiazepine antagonist and is used to reverse the effects of benzodiazepines, such as diazepam, in cases of overdose.

Question 19

A pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider?

Accepted Answer

The provider should first determine how much alcohol was consumed and at which stage of pregnancy to assess potential risk and provide appropriate counseling and care.

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?

Accepted Answer

Providing mechanical ventilation and oxygen to manage respiratory depression

Quiz 8: Substance Use Disorders

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 patient who just found out she is pregnant requests pharmacologic aids to help her quit smoking. The provider will give her what information?

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?

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 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?

The provider is discussing the management of prescribed, controlled substances with a patient. Which statement by the patient indicates understanding of the information provided?

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 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 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?

What is the provider's ideal goal of drug rehabilitation?

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?

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?

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?

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 provider, prescribing pain medication to each patient, will be most concerned about which patient developing a substance use disorder?

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 pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider?

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?

Quiz 8: Substance Use Disorders

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 patient who just found out she is pregnant requests pharmacologic aids to help her quit smoking. The provider will give her what information?

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?

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 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?

The provider is discussing the management of prescribed, controlled substances with a patient. Which statement by the patient indicates understanding of the information provided?

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 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 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?

What is the provider's ideal goal of drug rehabilitation?

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?

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?

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?

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 provider, prescribing pain medication to each patient, will be most concerned about which patient developing a substance use disorder?

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 pregnant patient is afraid she may have harmed her fetus by consuming alcohol. What is the appropriate response by the provider?

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 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?