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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
(Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. 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.)
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
(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. See relationship to audience response question.)
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
(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.)
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
(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.)
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
(Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.)
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
(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. Introjectioninvolves incorporating a quality of another person or group into one's own personality.)
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) 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.)
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
(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.)
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 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.)
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
(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.)
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
(The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.)
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
(The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis. See relationship to audience response question. (Educators may alter this question to multiple answers if desired.))
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.
B, C, F
(The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.)
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, E
(Care of patients who have taken bath salts is similar to those who have used other stimulants. Tachycardia and chest pain are common when a patient has used bath salts. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behavior and/or paranoia; therefore, safety is a priority concern. Nutrition is not a priority in an overdose situation. Vitamin replacements and naloxone apply to other drugs of abuse.)
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, D
(The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.)
Benzodiazepines are useful for treating alcohol withdrawal because they are associated with which action?
Blocking cortisol secretion
Increasing dopamine release
Decreasing serotonin availability
Exerting a calming effect
Exerting a calming effect
Which signs and symptoms are associated with opioid withdrawal?
Lacrimation, rhinorrhea, dilated pupils, and muscle aches.
Illusions, disorientation, tachycardia, and tremors.
Fatigue, lethargy, sleepiness, and convulsions.
Synesthesia, depersonalization, and hallucinations.
Lacrimation, rhinorrhea, dilated pupils, and muscle aches.
A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating which defense mechanism?
Denial
Projection
Rationalization
Reaction formation
Denial
A syndrome that occurs after stopping the long-term use of a drug is called
amnesia.
tolerance.
enabling.
withdrawal.
withdrawal.
The term tolerance, as it relates to substance abuse, refers to which situation?
The use of a substance beyond acceptable societal norms
The additive effects achieved by taking two drugs with similar actions
The signs and symptoms that occur when an addictive substance is withheld
The need to take larger amounts of a substance to achieve the same effects
The need to take larger amounts of a substance to achieve the same effects
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what substance?
Select all that apply.
Rohypnol
Gamma-hydroxybutyrate (GHB)
ReVia
Clonidine
Ayahuasca
Rohypnol
Gamma-hydroxybutyrate (GHB)
A teaching need is revealed when a client taking disulfiram (Antabuse) states:
"I usually treat heartburn with antacids."
"I take ibuprofen or acetaminophen for headache."
"Most over-the-counter cough syrups are safe for me to use."
"I have had to give up using aftershave lotion."
"Most over-the-counter cough syrups are safe for me to use."
Cocaine exerts which of the following effects on a client?
Stimulation after 15 to 20 minutes
Stimulation and euphoria
Immediate imbalance of emotions
Paranoia
Stimulation and euphoria
Nursing assessment of an alcohol-dependent client 6 to 8 hours after the last drink would most likely reveal the presence of which early sign of alcohol withdrawal?
Tremors
Seizures
Blackouts
Hallucinations
Tremors
A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive. What nursing intervention should be implemented to best assure the safety of the client and the milieu?
Select all that apply.
Taking him to the gym on the psychiatric unit
Obtaining an order for seclusion and close observation
Assigning a psychiatric technician to "talk him down"
Administering naltrexone as needed per hospital protocol
Obtaining a prescription for a benzodiazepine
Obtaining an order for seclusion and close observation
Obtaining a prescription for a benzodiazepine
What is an appropriate long-term client-centered goal/outcome for a recovering substance abuser.
Ability to discuss the addiction with significant others.
State an intention to stop using illegal substances.
Abstain from the use of mood-altering substances.
Substitute a less addicting drug for the present drug.
Abstain from the use of mood-altering substances
A client has a 4 year history of using cocaine intranasally. When brought to the hospital in an unconscious state, what nursing measure should be included in the client's plan of care?
Induction of vomiting
Administration of ammonium chloride
Monitoring of opiate withdrawal symptoms
Observation for tachycardia and seizures
Observation for tachycardia and seizures
A client being prepared for discharge tells the nurse, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone?
"It helps your mood so that you don't feel the need to do drugs."
"It will keep you from experiencing flashbacks."
"It is a sedative that will help you sleep at night so you are more alert and able to make good decisions."
"It helps prevent relapse by reducing drug cravings."
"It helps prevent relapse by reducing drug cravings."
The treatment team meets to discuss a client's plan of care. Which of the following factors will be priorities when planning interventions?
Readiness to change and support system
Current college performance
Financial ability
Availability of immediate family to come to meetings
Readiness to change and support system
A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for this client's treatment plan while in the hospital?
Client will return to a predrug level of functioning within 1 week.
Client will be medically stabilized while in the hospital.
Client will state within 3 days that they will totally abstain from drugs and alcohol.
Client will take a leave of absence from college to alleviate stress.
Client will be medically stabilized while in the hospital.
Which statement is true regarding substance addiction and medical comorbidity?
Most substance abusers do not have medical comorbidities.
There has been little research done regarding substance addiction disorders and medical comorbidity.
Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.
Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
A 26-year-old patient who abuses heroin states to you, "I've been using more heroin lately because I've begun to need more to feel the effect I want." What effect does this statement describe?
Intoxication
Tolerance
Withdrawal
Addiction
Tolerance
1. A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Whichphysical effects support the suspicion that the patient has relapsed? Select all that apply.
a. Intense nausea
b. Diaphoresis
c. Acute paranoia
d. Confusion
e. Dyspnea
a,b,d,e
2. Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply.
a. Pupils are dilated
b. Pulse rate is 62 beats/min
c. Slow movements
d. Extreme anxiety
e. Sleepy
a,d
3. The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply.
a. Reports inability to cope
b. Does not perceive danger of substance use or gambling
c. Minimizes symptoms
d. Refuses healthcare attention
e. Unable to admit impact of disease on life pattern
b,c,d,e
4. What action should you take when a female staff member is demonstrating behaviors associated with asubstance use disorder?
a. Accompany the staff member when she is giving patient care.
b. Offer to attend rehabilitation counseling with her.
c. Refer her to a peer assistance program.
d. Confront her about your concerns and/or report your concerns to a supervisor immediately.
d
5. A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitationprogram. What initial nursing intervention during the early days after admission will help ensure the patient's success?
a. Restrict visitors to family members only.
b. Manage the patient's withdrawal symptoms well.
c. Provide the patient a low stimulus environment.
d. Advocate for at least 3 months of treatment.
b
6. Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings accountis down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states:
a. "I understand that I am a bad person for depleting our savings."
b. "Gambling activates the reward pathways in my brain."
c. "Gambling is the only thing that makes me feel alive."
d. "We have always enjoyed gaming. I do not know why Eileen is so upset."
b
7. Opioid use disorder is characterized by:
a. Lack of withdrawal symptoms
b. Intoxication symptoms of pupillary dilation, agitation, and insomniac.
c. Tolerance
d. Requiring smaller amounts of the drug to achieve a high over time
c
8. Terry is a young male in a chemical dependency program. Recently he has become increasingly distractedand disengaged. The nurse concludes that Terry is:
a. Bored
b. Depressed
c. Bipolar
d. Not ready to change
d
9. Maxwell is a 30-year-old male who arrives at the emergency department stating, "I feel like I am having astroke." During the intake assessment, the nurse discovers that Maxwell has been working for 36 hours straight without eating and has consumed eight double espresso drinks and 12 caffeinated sodas. The nurse suspects:
a. Fluid overload
b. Dehydration and caffeine overdose
c. Benzodiazepine overdose
d. Sleep deprivation syndrome
b
10. Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiplescabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is:
a. Risk for injury/Remains free from injury
b. Ineffective denial/Accepts responsibility for behavior
c. Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs
d. Risk for suicide/Expresses feelings, plans for the future
c
