Chapter 70: Substance Use Disorders in the Adult Population

For a diagnosis of substance use disorder (SUD) based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the nurse correlates which behavior

to the criteria of the person exhibiting tolerance?

1. Persistent desire to cut down or control substance use

2. Substance used to avoid withdrawal symptoms

3. Markedly decreased effect of substance with continued use

4. Recurrent substance use in physically hazardous situations

Markedly decreased effect of substance with continued use

The nurse is caring for a patient who requires an opiate medication for chronic pain associated with a previous injury. The patient tells the nurse, “Even though I don’t feel like I’m addicted to the medication, I get tremors in my hands if I miss a dose.” What is the nurse’s best

response?

1. “You may be addicted to the medication, but not necessarily physically dependent.”

2. “You may be physically dependent on the medication, but not necessarily addicted.”

3. “The symptoms you describe are indicative of addiction, whether you feel you are

or not.”

4. “The symptoms you describe relate to your disease state and are not normal.”

"You may be physically dependent on the medication, but not necessarily addicted."

The nurse provides education regarding commonly used addictive substances. Which participant statement indicates a need for additional teaching?

1. “Tobacco and cannabis are both smoked.”

2. “LSD (lysergic acid diethylamide) is smoked and absorbed through the lungs.”

3. “PCP (phencyclidine) is injected, snorted, smoked, or swallowed.”

4. “Barbiturates can be injected, swallowed, or snorted.”

"LSD (lysergic acid diethylamide) is smoked and absorbed through the lungs."

A patient being treated for an alcohol use disorder asks the nurse, “Can my children inherit this?” Which response by the nurse is most appropriate?

1. “There does not seem to be a relationship between genetics and environment.”

2. “Genetics does not seem to play a role in the development of substance use disorders.”

3. “Genetics influences the risk for substance use disorders.”

4. “Genetics plays a major role in the development of substance use disorders.”

"Genetics influences the risk for substance use disorders."

The school nurse includes which information regarding alcohol and substance use in a teaching session for parents of middle school students?

1. “There is no correlation between age of first use of an addictive substance and subsequent use.”

2. “Substances affect the developing brain in teenagers, which may lead to further use of alcohol or other substances.”

3. “The development of alcohol use disorder is associated with beginning to drink before the age of 12.”

4. “There is no correlation between teen use of alcohol and subsequent use of other addictive substances.”

"Substances affect the developing brain in teenagers, which may lead to further use of alcohol or other substances."

The nurse is providing an educational seminar for the families of patients diagnosed with a substance use disorder. Which statement does the nurse include in the teaching session regarding the addictive process?

1. “Manifestations exhibited are similar to those exhibited with behavioral disorders.”

2. “Manifestations exhibited are similar to those exhibited with cognitive disorders.”

3. “Manifestations exhibited are caused by changes in neurochemistry.”

4. “Manifestations exhibited are caused by changes in the emotional state."

"Manifestations exhibited are caused by changes in neurochemistry."

The nurse correlates which findings to the use of a hazardous substance in the patient presenting to the emergency department after a motor vehicle crash?

1. The patient is agitated.

2. The patient’s pupils are dilated.

3. The patient’s spouse states, “He seems so secretive lately.”

4. The patient has an angry outburst when asked, “Have you been drinking?”

The patient's pupils are dilated.

The nurse monitors for which clinical manifestations in the patient demonstrating signs of severe alcohol withdrawal syndrome (AWS)?

1. Fine tremor

2. Mild insomnia

3. Profuse diaphoresis

4. Moderate hypotension

Profuse diaphoresis

Ten hours after admission to the intensive care unit after an auto accident, a patient begins to exhibit mild tachycardia, irritability, and tremors. Three hours later the patient has a grand mal seizure. The nurse correlates these finding to which disorder?

1. Wernicke encephalopathy

2. Korsakoff syndrome

3. Renal insufficiency

4. Alcohol withdrawal syndrome

Alcohol withdrawal syndrome

The patient with a history of alcohol abuse is being discharged to a treatment facility. The nurse prepares to teach the patient about which prescribed medication?

1. Disulfiram

2. Naloxone

3. Bupropion hydrochloride

4. Varenicline

Disulfiram

The nurse is providing care to a patient with alcohol and opioid dependency and a family member states, “I don't understand why naltrexone treatment is prescribed because it causes a high too, right?” Which response by the nurse is best?

1. “Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs.”

2. “Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer.”

3. “Naltrexone diminishes the cravings your daughter will feel for alcohol and opioids.”

4. “Naltrexone will prevent your daughter from getting drunk when she drinks.”

"Naltrexone diminishes the cravings your daughter will feel for alcohol and opioids."

A college student is incoherent after taking “barbs with beer.” The emergency department nurse recognizes that this patient is at risk for which complication?

1. Hallucinations

2. Respiratory depression

3. Seizure activity

4. Signs of withdrawal

Respiratory depression

The nurse monitors for which initial clinical manifestations in the patient experiencing opioid withdrawal?

1. Myalgia

2. Anorexia

3. Rhinorrhea

4. Tachycardia

Rhinorrhea

A patient addicted to heroin is prescribed methadone as part of the treatment process. The patient’s spouse asks, “I don’t understand the reason for the methadone treatment. Why replace heroin with methadone?” Which response by the nurse is accurate?

1. “Methadone is safe even in large doses.”

2. “Methadone replaces a more potent drug.”

3. “Methadone is a deterrent to using other drugs.”

4. “Methadone blocks the craving for and the action of opiates.”

"Methadone blocks the craving for and the action of opiates."

A patient is brought to the emergency department by a family member who reports that the patient has been acting strangely for the past three hours and is hyper-vigilant, grandiose, and irritable. Based on this data, along with vital signs reveal hypertension, tachycardia, and

arrhythmias, the nurse correlates to the use of which substance?

1. Alcohol

2. Marijuana

3. Heroin

4. Cocaine

Cocaine

Which statement by the family member of a patient regarding treatment for a substance abuse disorder indicates the need for further teaching?

1. “Treatment mandated by the judge may be required because of the use of illegal drugs.”

2. “Treatment is only effective if he enters voluntarily.”

3. “Mandated treatment may be what is needed to get the process started.”

4. “Family involvement will be important to treatment effectiveness.”

"Mandated treatment may be what is needed to get the process started."

A nurse from the local Public Health Clinic is conducting a class in the community regarding alcohol use to a group of college seniors. What is the priority action by the nurse if a student discloses frequent alcohol use during the class?

1. Initiate a community assessment of the campus

2. Contact the campus healthcare provider and refer the student

3. Notify campus security to watch for driving under the influence

4. Complete a screening assessment

Complete a screening assessment

The nurse monitors for clinical manifestations of gout in the patient with a history of use of which substance?

1. Alcohol

2. Cocaine

3. Heroin

4. Oxycontin

Alcohol

In preparing to assess a patient’s pattern of substance use, which instrument does the nurse administer that includes four “yes” or “no” questions?

1. AUDIT-C

2. CAGE questionnaire

3. CIWA-Ar

4. SBIRT

CAGE questionnaire

A patient who is attending a Narcotics Anonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. When responding to the patient, which indication does the nurse focus as the priority?

1. To admit to having a problem

2. To learn problem-solving skills

3. To take a moral inventory of self

4. To make amends to people they have hurt

To admit to having a problem

The nurse assesses a patient with a history of alcohol use disorder who is hospitalized with anorexia, dysphagia, odynophagia, and chest pressure after eating. Which nursing diagnosis is a priority for this patient?

1. Ineffective Coping

2. Imbalanced Nutrition: Less Than Body Requirements

3. Disturbed Sensory Perception

4. Disturbed Thought Processes

Imbalanced Nutrition: Less Than Body Requirements

In planning care for the patient experiencing alcohol withdrawal, what is the priority nursing diagnosis?

1. Risk for Injury

2. Ineffective Coping

3. Disturbed Sensory Perception

4. Disturbed Thought Processes

Risk for Injury

The nurse is conducting a health history for a patient and wants to determine the patient’s alcohol use. Which question by the nurse provides the best information?

1. “Are you a heavy drinker?”

2. “How many alcoholic beverages do you drink each day?”

3. “Is alcohol use a concern for you?”

4. “Does your drinking cause any problems for you?”

"How many alcoholic beverages do you drink each day?"

The nurse is providing care to a patient diagnosed with alcohol use disorder who has a body mass index (BMI) of 18. The nurse prepares to administer which prescribed medication based on these physical assessment findings?

1. Sertraline

2. Methadone

3. Naloxone

4. Multivitamin with folic acid

Multivitamin with folic acid

After an assessment of a patient, a nursing student expresses a belief that drug addiction is not a real illness, as these patients “did it to themselves.” Which response by the staff nurse is best?

1. “Sometimes a patient doesn't show much effort.”

2. “We are legally obligated to provide care.”

3. “It is important to remain nonjudgmental when caring for any patient, even a drug addict.”

4. “You are right. I don't know why we bother.”

"It is important to remain nonjudgmental when caring for any patient, even a drug addict."

The nurse monitors for which risk factors for substance use disorders in adult patients? Select all that apply.

1. A history of sexual abuse

2. A history of bipolar disorder

3. Crisis events, such as an assault

4. An individual with poor social skills

5. A parent with a history of alcohol abuse

1. A history of sexual abuse

2. A history of bipolar disorder

3. Crisis events, such as an assault

4. An individual with poor social skills

5. A parent with a history of alcohol abuse

Multiple Response

The nurse monitors for which clinical manifestations in the patient under the influence of “ecstasy” (MDMA; 3,4 methylenedioxymethamphetamine)? Select all that apply.

1. Decreased respiratory rate

2. Hypertension

3. Hyperthermia

4. Euphoria

5. Tachycardia

2. Hypertension

3. Hyperthermia

4. Euphoria

5. Tachycardia

The nurse monitors for which clinical manifestations of withdrawal in the patient diagnosed with substance use disorder? Select all that apply.

1. Cravings

2. Drowsiness

3. Euphoria

4. Seizures

5. Tremors

1. Cravings

4. Seizures

5. Tremors

The nurse monitors for which clinical manifestations in the patient admitted for treatment of alcohol use disorder? Select all that apply.

1. Serum albumin 3.0 g/dL

2. Serum calcium 12.5 mg/dL

3. Serum glucose 65 mg/dL

4. Serum magnesium 0.8 mg/dL

5. Serum potassium 2.8 mEq/L

1. Serum albumin 3.0 g/dL

3. Serum glucose 65 mg/dL

4. Serum magnesium 0.8 mg/dL

5. Serum potassium 2.8 mEq/L

Which are the priority nursing interventions when providing care to patients at various stages of the detoxification process? Select all that apply.

1. Vital signs

2. Medication administration

3. Motivational interviewing

4. Intake and output

5. Neurological assessment

1. Vital signs

2. Medication administration

4. Intake and output

5. Neurological assessment