Varcarolis Chapter 22 Substance Related and Addictive Disorders

1. A patient diagnosed with alcoholism 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."

b. "An individual is supported by peers while striving for abstinence one day at a time."

2. 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/min

0400: 126/80 mm Hg and 76 beats/min

0600: 128/82 mm Hg and 72 beats/min

0800: 132/88 mm Hg and 80 beats/min

1000: 148/94 mm Hg and 96 beats/min

What is the nurse's priority action?

a. Force fluids.

b. Consult the health care provider.

c. Obtain a clean-catch urine sample.

d. Place the patient in a vest-type restraint.

b. Consult the health care provider..

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

a. Cardiovascular

b. Respiratory

c. Neurologic

d. Hepatic

b. Respiratory

4. 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/min. 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.

c. has symptoms of alcohol-withdrawal delirium.

5. A patient admitted yesterday for injuries sustained while intoxicated believes bugs 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. Risk for injury

6. A hospitalized patient diagnosed with an alcohol abuse 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 (Dilaudid).

b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium).

c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril).

d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium).

7. A hospitalized patient diagnosed with an alcohol abuse 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

b. One-on-one supervision

8. A patient diagnosed with an alcohol abuse 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."

d. "Tell me what happened the last time you drank."

9. A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. "Alcoholics Anonymous 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."

b. self-help group for which the goal is sobriety."

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior 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.

b. has a high tolerance to alcohol.

11. A patient admitted to an alcoholism 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

a. Denial

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

a. Bromocriptine (Parlodel)

b. Methadone (Dolophine)

c. Disulfiram (Antabuse)

d. Naltrexone (ReVia)

d. Naltrexone (ReVia)

13. 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."

a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."

14. 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.

c. consider each diagnosis primary and provide simultaneous treatment.

15. 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

a. Empathetic, supportive

16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose?

a. Simple and safe

b. Active and bright

c. Stimulating and colorful

d. Confrontational and challenging

a. Simple and safe

17. 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.

a. Tolerance has developed.

18. 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.

a. codependence.

19. In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic 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/min, and respirations at or above 12 breaths/min.

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.

b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.

20. 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."

d. "Make your loved one responsible for the consequences of behavior."

21. Which goal for treatment of alcoholism should the nurse address first?

a. Learn about addiction and recovery.

b. Develop alternate coping strategies.

c. Develop a peer support system.

d. Achieve physiologic stability.

d. Achieve physiologic stability.

22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate?

a. 1-week detoxification program

b. Long-term outpatient therapy

c. 12-step self-help program

d. Residential program

d. Residential program

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.

a. Monitor vital signs.

b. Observe for depression.

c. Awaken the patient every 15 minutes.

d. Use warmers to maintain body temperature.

a. Monitor vital signs.

24. Symptoms of withdrawal from opioids for which the nurse should assess include:

a. dilated pupils, tachycardia, elevated blood pressure, and elation.

b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.

c. mood lability, incoordination, fever, and drowsiness.

d. excessive eating, constipation, and headache.

b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes:

a. cross-tolerance.

b. substance abuse

c. substance addiction.

d. substance intoxication.

c. substance addiction.

26. Which assessment findings are likely for an individual who recently injected heroin?

a. Anxiety, restlessness, paranoid delusions

b. Muscle aching, dilated pupils, tachycardia

c. Heightened sexuality, insomnia, euphoria

d. Drowsiness, constricted pupils, slurred speech

d. Drowsiness, constricted pupils, slurred speech

27. An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect:

a. a schizophrenic episode.

b. hallucinogen ingestion.

c. opium intoxication.

d. cocaine overdose.

b. hallucinogen ingestion.

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information?

a. Substance Abuse and Mental Health Services Administration (SAMHSA)

b. Institute of Medicine - National Research Council (IOM)

c. National Council of State Boards of Nursing (NCSBN)

d. American Society of Addictions Medicine

a. Substance Abuse and Mental Health Services Administration (SAMHSA)

29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely?

a. PCP

b. Heroin

c. Barbiturates

d. Amphetamines

d. Amphetamines

30. Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will:

a. state, "I know I need long-term treatment."

b. use denial and rationalization in healthy ways.

c. identify constructive outlets for expression of anger.

d. develop a trusting relationship with one staff member.

A. state, "I know I need long-term treatment."

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action?

a. Perform a thorough assessment of the patient.

b. Verify that security services are immediately available.

c. Self-assess personal attitude, values, and beliefs about this health problem.

d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

c. Self-assess personal attitude, values, and beliefs about this health problem.

1. A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (select all that apply)

a. avoid aged cheeses.

b. avoid alcohol-based skin products.

c. read labels of all liquid medications.

d. wear sunscreen and avoid bright sunlight.

e. maintain an adequate dietary intake of sodium.

f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F

b. avoid alcohol-based skin products.

c. read labels of all liquid medications.

f. avoid breathing fumes of paints, stains, and stripping compounds.

2. The nurse can assist a patient to prevent substance abuse relapse by: (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. advising isolating self from significant others until sobriety is established.

e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

ANS: A, C, E

a. rehearsing techniques to handle anticipated stressful situations.

c. assisting the patient to identify life skills needed for effective coping.

e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply)

a. administration of naloxone (Narcan).

b. vitamin B12 and folate supplements.

c. restoring nutritional integrity.

d. management of heart rate.

e. environmental safety.

d. management of heart rate.

e. environmental safety.

4. A new patient beginning an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Select the nurse's most therapeutic responses. Select all that apply.

a. "I see," and use interested silence.

b. "I think you are drinking more than you report."

c. "Social drinkers have one or two drinks, once or twice a week."

d. "You describe drinking steadily throughout the day and evening."

e. "Your comments show denial of the seriousness of your problem."

c. "Social drinkers have one or two drinks, once or twice a week."

d. "You describe drinking steadily throughout the day and evening."