Substance-Related and Addictive Disorders- Practice Questions

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)

B

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 presents with what related characteristic?

A. Jaundice

B. Dependent on alcohol

C. Healthy but underweight

D. Facial abnormalities and cognitive impairment

D

A patient was admitted 1 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's response is described by what term?

A. An illusion

B. A delusion

C. Hallucinations

D. Hypnagogic phenomenon

A

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/min. 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?

A. The patient is attempting to obtain attention by manipulating staff.

B. The patient may have sustained a head injury before admission.

C. The patient has symptoms of alcohol withdrawal delirium.

D. The patient is having a recurrence of an acute psychosis.

C

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

D

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

B. Phenothiazine, such as thioridazine

C. Benzodiazepine, such as lorazepam

D. Narcotic analgesic, such as morphine

C

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.

C

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."

D

A patient asks for information about the goals of 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."

A

11. 12. 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.

Considering the relationship between behavior and blood alcohol level, which conclusion can

the nurse draw?

A. The patient rarely drinks alcohol.

B. The patient has a high tolerance to alcohol.

C. The patient has been treated with disulfiram.

D. The patient has recently ingested both alcohol and sedative drugs.

B

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

D

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?"

D

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."

B

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.

A

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

A

A patient comes to an outpatient appointment obviously intoxicated. The nurse should

implement what intervention?

A. Exploring the patient's reasons for drinking today

B. Arranging admission to an inpatient psychiatric unit

C. Coordinating emergency admission to a detoxification unit

D. Telling the patient, "We cannot see you today because you've been drinking"

D

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.

A

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.

A

A patient admitted for a heroin overdose received naloxone. 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.

C

In the emergency department, a patient's vital signs are: blood pressure (BP), 66/40 mm Hg;

pulse (P), 140 beats/min (bpm); and respirations (R), 8 breaths per minute and shallow. The

patient overdosed on illegally obtained hydromorphone. What is the priority outcome for this

patient?

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.

A

Select the nursing intervention necessary after administering naloxone 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.

A

A graduate 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. Changing employment after only several months

B. Seeking to be assigned as a medication nurse

C. Frequent socializes with unit staff after work

D. Recent graduate

B

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

A

Which treatment approach is most appropriate for a patient with poor social skills who has

been treated several times for substance addiction but has relapsed?

A. 1-week detoxification program

B. Long-term outpatient therapy

C. 12-step self-help program

D. Residential program

D

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

B

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.

D

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

C

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

B

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

D

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

withdrawal symptoms?

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

C

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.

D

An adult in the emergency department states, "I feel restless. Everything I look is wavy.

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 what triggered these reports?

A. Cocaine overdose

B. Schizophrenic episode

C. Phencyclidine (PCP) intoxication

D. Lysergic acid diethylamide (LSD) ingestion

D

In what significant ways is the therapeutic environment different for a patient who has

ingested 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.

A

When assessing a patient who has ingested flunitrazepam, what should the nurse expect?

A. Acrophobia

B. Hypothermia

C. Hallucinations

D. Anterograde amnesia

D

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.

C

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

B. Bromocriptine

C. Disulfiram

D. Naltrexone

D

Select the most appropriate outcome for a patient completing the fourth alcohol detoxification

program in 1 year. Before discharge, what will the patient do?

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.

B

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?"

B

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

A

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."

ANS: A

The answer reflects the AA belie

A

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. Nosebleed, muscle wasting, and impaired hearing

D

A patient undergoing alcohol rehabilitation decides to accept disulfiram therapy to avoid

impulsively responding to drinking cues. Which information should be included in the

discharge teaching for this patient? (Select all that apply.)

1. Avoid aged cheeses.

2. Read labels of all liquid medications.

3. Wear sunscreen and avoid bright sunlight.

4. Maintain an adequate dietary intake of sodium.

5. Avoid breathing fumes of paints, stains, and stripping compounds.

A. 2,5

B. 1,3

C. 4,5

D. 2,4

A

A nurse can assist a patient diagnosed with addiction and the patient’s family in which aspects

of relapse prevention? (Select all that apply.)

1. Rehearsing techniques to handle anticipated stressful situations

2. Advising the patient to accept residential treatment if relapse occurs

3. Assisting the patient to identify life skills needed for effective coping

4. Isolating self from significant others and social situations until sobriety is

established

5. Teaching the patient about the physical changes to expect as the body adapts to

functioning without substances

A. 1,4,5

B. 2,3,4

C. 1,3,5

D. 1,2,4

C

While caring for a patient with a methamphetamine overdose, which tasks are the priorities of

care? (Select all that apply.)

1. Administration of naloxone (Narcan)

2. Vitamin B12 and folate supplements

3. Restoring nutritional integrity

4. Prevention of seizures

5. Reduction of fever

A. 1,2

B. 2,3

C. 3,4

D. 4,5

D