Question 1

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

Accepted Answer

Low self-esteem is present when a patient sees himself or herself as inadequate. It is a chronic problem because it is a lifelong feeling for the patient. Data are not present to support the other options.

Question 2

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.

Accepted Answer

Narcotic antagonists such as naloxone quickly reverse CNS depression; however, because the narcotics have a longer duration of action than antagonists, the patient may lapse into unconsciousness or require respiratory support again. The incorrect options are measures unrelated to naloxone use.

Question 3

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)

Accepted Answer

Naltrexone is useful for treating both opioid and alcohol addictions. As an opioid antagonist, it blocks the action of opioids. Because it blocks the mechanism of reinforcement, it also reduces or eliminates alcohol craving.

Question 4

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."

Accepted Answer

The answer reflects the AA beliefs. The incorrect options each contain a statement that suggests early relapse.

Question 5

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.

Accepted Answer

The answer refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not provide enough information to know whether anger has been identified as a problem. A trusting relationship, although desirable, would not help the patient maintain sobriety.

Question 6

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?"

Accepted Answer

Learning when the patient had the last drink is essential to knowing when to begin to observe for symptoms of withdrawal. The other questions are relevant but of lower priority.

Question 7

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.

Accepted Answer

The patient who has ingested LSD often experiences synesthesia (visions in sound), depersonalization, and concerns about going "crazy." Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. PCP use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

Question 8

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

Accepted Answer

The symptoms of withdrawal from various CNS depressants are similar. Generalized seizures are possible.

Question 9

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

Accepted Answer

Nicotine meets the criteria for a substance. Criteria for addiction are present: compulsive use, craving, tolerance and withdrawal symptoms. The scenario does not meet the criteria for substance abuse, intoxication, or recreational use of a social drug.

Question 10

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.

Accepted Answer

Both lorazepam and alcohol are CNS depressants and have synergistic effects. Taken together, the action of each would potentiate the other.

Question 11

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.

Accepted Answer

Rebound depression occurs with the withdrawal from CNS stimulants, probably related to neurotransmitter depletion. Touch may be misinterpreted if the patient is experiencing paranoid tendencies. Concentration is impaired during withdrawal. Denying requests is inappropriate; maintaining established limits will suffice.

Question 12

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

Accepted Answer

Lorazepam is a benzodiazepine. Maintaining a patent airway is the priority when the patient is unconscious. Assessing neurologic function by testing reflexes and checking pupils can wait. Vomiting should not be induced when a patient is unconscious because of the danger of aspiration.

Question 13

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.

Accepted Answer

Enabling denies the seriousness of the patient's problem or supports the patient as he or she shifts responsibility from self to circumstances. The incorrect options are therapeutic and appropriate.

Question 14

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.

Accepted Answer

Patients who have ingested LSD respond well to being "talked down" by a supportive person. Patients who have ingested PCP are very sensitive to stimulation and display frequent, unpredictable, and violent behaviors. Although one person should perform care and talk gently to the patient, no one individual should be alone in the room with the patient. An adequate number of staff members should be gathered to manage violent behavior if it occurs.

Question 15

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.

Accepted Answer

The nurse intent on diverting drugs for personal use often attempts to isolate him- or herself from peers rather than being sociable. The person seeks access to medications, which is a component of drug seeking behavior. Usually, the person will blame errors on others rather than accepting responsibility.

Question 16

When assessing a patient who has ingested flunitrazepam (Rohypnol), the nurse would expect:
A) acrophobia.
B) hypothermia.
C) hallucinations.
D) anterograde amnesia.

Accepted Answer

Flunitrazepam is known as the date rape drug. It produces disinhibition and a relaxation of voluntary muscles, as well as anterograde amnesia for events that occur. The other options do not reflect symptoms commonly observed after use of this drug.

Question 17

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

Accepted Answer

Both types of patients commonly experience paranoid delusions; thus, the nursing diagnosis of disturbed thought processes is appropriate for both. The incorrect options are not specifically applicable to both.

Question 18

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

Accepted Answer

Residential programs and therapeutic communities have goals of complete change in lifestyle, abstinence from drugs, elimination of criminal behaviors, development of employable skills, self-reliance, and honesty. Residential programs are more effective than outpatient programs for patients with antisocial tendencies.

Question 19

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

Accepted Answer

Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations are decreased, and attention is impaired. The incorrect options describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine abuse.

Question 20

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.

Accepted Answer

Early signs and symptoms of narcotic withdrawal resemble symptoms of onset of a flulike illness, but without temperature elevation. The incorrect options reflect signs of intoxication or CNS depressant overdose and CNS stimulant or hallucinogen use.

Quiz 19: Substance-Related and Addictive Disorders

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?

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

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?

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

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

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

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:

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

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 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?

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

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 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?

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) ?

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

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

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

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

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: