Question 1

A nurse cares for a patient experiencing an opioid overdose. Which focused assessment has the highest priority?
A) Cardiovascular
B) Respiratory
C) Neurological
D) Hepatic

Accepted Answer

Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority.

Question 2

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?
A) Bromocriptine
B) Methadone
C) Disulfiram
D) Naltrexone

Accepted Answer

Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

Question 3

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse 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) "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."
B) "It will be important for you to structure life to avoid as much stress as you can and provide social protection."
C) "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully."
D) "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

Accepted Answer

During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

Question 4

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/minute; respirations 8 breaths/minute and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to opioid intoxication. Select the priority outcome.
A) The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization.
B) Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/minute, and respirations at or above 12 breaths/minute.
C) The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department.
D) Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

Accepted Answer

The correct short-term outcome is the only one that relates to the patient's physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patient's respirations are slow and shallow, but there is no evidence of congestion.

Question 5

A patient diagnosed with alcohol use disorder asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response.
A) "The goal of AA is for members to learn controlled drinking with the support of a higher power."
B) "An individual is supported by peers while striving for abstinence one day at a time."
C) "You must make a commitment to permanently abstain from alcohol and other drugs."
D) "You will be assigned a sponsor who will plan your treatment program."

Accepted Answer

Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

Question 6

Which features should be present in a therapeutic milieu for a patient experiencing a hallucinogen overdose?
A) Simple and safe
B) Active and bright
C) Stimulating and colorful
D) Confrontational and challenging

Accepted Answer

Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

Question 7

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) Tolerance has developed.
B) Antagonistic effects are evident.
C) Metabolism of the alcohol is now delayed.
D) Pharmacokinetics of the alcohol have changed.

Accepted Answer

Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

Question 8

A hospitalized patient diagnosed with alcohol use disorder 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

Accepted Answer

One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

Question 9

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response.
A) "Alcoholism is a lifelong disease. Relapses are expected."
B) "Use search and destroy tactics to keep the home alcohol free."
C) "It's important that you visit your family member on a regular basis."
D) "Make your loved one responsible for the consequences of behavior."

Accepted Answer

Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

Question 10

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. 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.

Accepted Answer

Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

Question 11

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as
A) codependence.
B) assertiveness.
C) role reversal.
D) homeostasis.

Accepted Answer

Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario.

Question 12

Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction.
A) Empathetic, supportive
B) Skeptical, guarded
C) Cool, distant
D) Confrontational

Accepted Answer

Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

Question 13

A patient diagnosed with alcohol use disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking 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."

Accepted Answer

The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

Question 14

A patient asks for information about AA. Select the nurse's best response. "AA 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."

Accepted Answer

AA is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

Question 15

A patient admitted yesterday for injuries sustained while intoxicated believes insects 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

Accepted Answer

The patient's clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

Question 16

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates poor coordination and slurred speech but the vital signs are normal. The blood alcohol level is 300 mg/dL (0.30 g/dL). Considering the relationship between the assessment findings 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.

Accepted Answer

A nontolerant drinker would have sleepiness and significant changes in vital signs with a blood alcohol level of 300 mg/dL (0.30 g/dL). The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

Question 17

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/minute
0400: 126/80 mm Hg and 76 beats/minute
0600: 128/82 mm Hg and 72 beats/minute
0800: 132/88 mm Hg and 80 beats/minute
1000: 148/94 mm Hg and 96 beats/minute
What is the nurse's priority action?
A) Force fluids.
B) Begin the detox protocol.
C) Obtain a clean-catch urine sample.
D) Place the patient in a vest-type restraint.

Accepted Answer

Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for detox with medical intervention to prevent a hypertensive crisis and/or seizures. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

Question 18

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/minute. 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.

Accepted Answer

Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

Question 19

A hospitalized patient diagnosed with alcohol use disorder 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(n)
A) narcotic analgesic, such as hydromorphone.
B) sedative, such as lorazepam or chlordiazepoxide.
C) antipsychotic, such as olanzapine or thioridazine.
D) monoamine oxidase inhibitor antidepressant, such as phenelzine.

Accepted Answer

Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

Question 20

A patient admitted to an alcohol rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism?
A) Denial
B) Projection
C) Introjection
D) Rationalization

Accepted Answer

Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjection involves incorporating a quality of another person or group into one's own personality.

Quiz 22: Substance-Related and Addictive Disorders

A nurse cares for a patient experiencing an opioid overdose. Which focused assessment has the highest priority?

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse 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 patient diagnosed with alcohol use disorder asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response.

Which features should be present in a therapeutic milieu for a patient experiencing a hallucinogen overdose?

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 hospitalized patient diagnosed with alcohol use disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated?

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response.

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as

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

A patient diagnosed with alcohol use disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively?

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

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

A hospitalized patient diagnosed with alcohol use disorder 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(n)

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