Substance Abuse Practice Questions

A patient tells the nurse that she plans to become pregnant and asks if she can continue to drink during her pregnancy. Which is the best response by the nurse? "It depends on how many alcohol drinks you consume and when you expect to become pregnant." "An occasional glass of wine won't cause any harm." "Because wine and other alcohol are legal, you might not realize the dangers to the fetus." "Alcohol consumption is harmful for both you and your baby. You should stop drinking before getting pregnant."

"Alcohol consumption is harmful for both you and your baby. You should stop drinking before getting pregnant."

A patient is admitted to the emergency department with alcohol intoxication. Which blood alcohol level (BAL) should the nurse suspect if the patient has trouble remaining upright? 0.25% 0.30% 0.15% 0.40%

0.25%

Which patient should the nurse consider to be at the highest risk of abusing alcohol? A 45-year-old patient with a deficiency of aldehyde dehydrogenase A 19-year-old patient who recently converted to Mormonism A 32-year-old patient with a history of acute postoperative pain managed with IV opioids A 23-year-old patient with impulsivity and risk-taking behaviors

A 23-year-old patient with impulsivity and risk-taking behaviors

The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors? Hypertension, changes in LOC, hallucinations Hypotension, ataxia, hunger Stupor, agitation, muscular rigidity Hypotension, coarse hand tremors, agitation

Hypertension, changes in LOC, hallucinations Some of the symptoms associated with delirium tremors typically are anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, and changes in LOC, agitation, fever, and delusions

A patient is experiencing alcohol withdrawal symptoms. Which clinical tool should the nurse use to determine the severity of withdrawal symptoms and indicate the need for pharmacologic treatment? CIWA-Ar B-DAST CAGE MAST

CIWA-Ar

A patient diagnosed with severe acute alcohol withdrawal is experiencing hyperthermia, sweating, and vomiting. Which nursing intervention would provide the patient with adequate hydration? Ensuring sodium supplementation Administering IV therapy as per the healthcare provider's directive Increasing oral fluid intake Removing any blankets and placing a fan in the room

Administering IV therapy as per the healthcare provider's directive

The nurse is caring for an adolescent patient diagnosed with alcoholism. The patient informs being frequently coerced by family to do things that cause feelings of unhappiness, such as turning over their entire paycheck or babysitting younger siblings. Which intervention should the nurse select to help the patient develop new coping skills? Assertiveness training Pain management Mindfulness training Thought stopping

Assertiveness training

The patient tells the nurse he only drinks alcohol twice a month in large quantities when out with friends. The nurse associates this behavior with which type of alcohol consumption? Binge drinking Alcohol dependence Social drinking Benchmark drinking

Binge drinking

A patient is concerned about having problems with drinking. He discloses to the nurse about having intense cravings for alcohol and often starts drinking after breakfast. Which tool is used to determine whether a patient has a problem with alcohol that may require treatment? Skin testing CAGE questionnaire Chest x-ray Magnetic resonance imaging (MRI)

CAGE questionnaire

The nurse determines that the wife of an alcoholic client is benefiting from attending Al-Anon group when she hears the wife say: "My attendance at the meetings has helped me to see that I provoke my husband's violence." "I no longer feel that I deserve the beatings my husband inflicts on me." "I can tolerate my husband's destructive behavior now that I know they are common with alcoholics." "I enjoy attending the meetings because they get me out of the house and away from my husband."

"I no longer feel that I deserve the beatings my husband inflicts on me." Al-Anon support groups are protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavior changes. Option 2 is the most healthy response because is exemplifies and understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control.

A patient is experiencing visual hallucinations during alcohol withdrawal. The patient is visibly upset and fearful. Which nursing statement best supports the patient? "I see that you are scared. I do not see what you describe, but I will stay with you in the room." "There is nothing in the room; you need to settle down." "I am going to see another patient; you are safe in your room." "Show me where you see something in the room, and I will prove it is not there."

"I see that you are scared. I do not see what you describe, but I will stay with you in the room."

While at the healthcare provider's office, a pregnant patient informs of being a recovering alcoholic and is looking for information regarding group supportive therapy. Which response by the nurse would meet the patient's need? "Have you considered inpatient treatment so that you can experience a recovery environment?" "We can speak to the provider about prescribing you Antabuse." "I can see if the provider can refer you to a behavioral therapist." "I will provide you with some information on the community's Alcoholics Anonymous meetings."

"I will provide you with some information on the community's Alcoholics Anonymous meetings."

The nurse is discussing the chemistry of alcohol dependence with a colleague. Which statement indicates the correct understanding of the neurotransmitters involved in alcohol dependence? "A deficiency of gamma-aminobutyric acid (GABA) is involved in alcohol dependence." "A deficiency of ETOH creates a dependence on alcohol." "Excess glutamate creates a dependence on alcohol." "Low levels of dopamine and serotonin are involved in alcohol dependence."

"Low levels of dopamine and serotonin are involved in alcohol dependence."

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse "I should get out of this bad situation." The most helpful response by the nurse would be: "I agree with you. You should get out of this situation." "What do you find difficult about this situation?" "Why don't you tell your husband about this?" "This is not the best time to make that decision."

"What do you find difficult about this situation?"

A patient with severe anxiety develops a pattern of using alcohol to help with symptom control. After 1 month of treatment in an outpatient setting, the patient is returning home. The nurse is completing the evaluation phase of the nursing process with the patient. Which patient statement supports an expected outcome? "It is important that I never get anxious again or let my worrying get hold of me." "It is expected that I will have difficulty with drinking again if my anxiety is severe." "If I remove myself from situations that make me anxious, I will not drink anymore." "When I get anxious, I will ensure that I am not in an environment where alcohol is available."

"When I get anxious, I will ensure that I am not in an environment where alcohol is available."

The nurse is caring for a patient admitted with alcohol dependence. The patient's family identifies significant neurologic changes in the patient over the past 2 months. The patient has lived with chronic alcoholism for 35 years. During assessment which symptom should the nurse recognize as characteristic of Korsakoff psychosis ? Confabulation Anuria Abnormal eye movements Ataxia

Confabulation

An 80-year-old patient presents with signs of alcohol intoxication. The patient's daughter cares for him and is concerned because her father has only one drink each evening. Which item, if found in the patient's belongings, would prompt the nurse to ask more questions? Nonsteroidal anti-inflammatory drugs Cough syrup Hard candies Antacids

Cough syrup

The nurse is caring for a patient with known alcohol abuse. The patient states he would like to start medication after he has completed alcohol withdrawal, but he does not want the drug that makes him vomit. He has heard there is a medication that helps reduce the craving for alcohol and would prefer that one. Which medication does the nurse recognize that the patient is referring to? Metoprolol tartrate (Lopressor) Disulfiram (Antabuse) Lorazepam (Ativan) Naltrexone (ReVia, Depade)

Naltrexone (ReVia, Depade)

A patient is experiencing alcohol withdrawal delirium (delirium tremens). The nurse administers a benzodiazepine. No seizure activity is noted. Which nursing intervention will promote patient comfort and safety at this time? Monitoring vital signs once every 8-hour shift Maintaining a darkened room Providing an environment that protects the patient and others Providing a liquid diet

Providing an environment that protects the patient and others

The nurse is completing health teaching with a 21-year-old college student who engages in frequent binge drinking at parties on the weekend but does not drink during the week. The patient is clear that abstaining from alcohol is not an option. Which teaching intervention would best promote the patient's safety and decrease the risk of future alcohol abuse? Encouraging the patient to have only one or two drinks per day, rather than binge drink Encouraging the patient to join a local club instead of going to parties Providing the patient with strategies to limit the number of drinks consumed at a party Teaching the patient that there is a decreased life expectancy associated with increased alcohol consumption

Providing the patient with strategies to limit the number of drinks consumed at a party

A patient is participating in a community-based social detoxification program with limited medical oversight for alcohol withdrawal. The nurse completes a visit to the site to assess the patient. Which assessment finding should prompt the nurse to notify the healthcare provider and consider moving the patient to an acute care setting? Report of a seizure High blood pressure Normothermia Anxiety

Report of a seizure

A patient is admitted to an ambulatory care unit after a minor surgical procedure. The nurse identifies that the patient may be experiencing mild alcohol withdrawal. Which symptom would support this assessment finding? The patient complains of fatigue. The patient is irritable and anxious. The patient is hyperthermic and has a seizure. The patient states that they are forgetful.

The patient is irritable and anxious.

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want anymore treatment. I have things that I have to do right away." The client has not been discharged. In fact, the client is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. The most important nursing action is to: Restrain the client until the physician can be reached Call security to block all areas Tell the client that the client cannot return to this hospital again if the client leaves now. Call the nursing supervisor.

Call the nursing supervisor. A nurse can be charged with false imprisonment if a client is made to believe wrongfully that the client cannot leave the hospital. Most health care facilities have documents that the client is asked to sign that relate to the client's responsibilities when the client leaves against medical advice. The client should be asked to sign this document before leaving. The nurse should request that the client wait to speak to the physician before leaving, but if the client refuses to do so, the nurse cannot hold him against his will. Restraining the client and calling security to block exits constitutes false imprisonment. Any client has a right to health care and cannot be told otherwise.

A 76-year-old patient is visiting the local health clinic. The nurse notes the patient is slightly confused and has an ataxic gait, slurred speech, poor hygiene, and smells of alcohol. Which disease condition should the nurse recognize that may mimic a substance abuse disorder in the patient? Anemia Dementia Hypothyroidism Coronary artery disease

Dementia

A patient presents with symptoms of upper gastrointestinal bleeding. Routine blood work and a blood alcohol level (BAL) are completed. Which other laboratory data may direct the nurse to suspect the patient has chronic alcoholism? Decreased aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT) Elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT) Elevated C-reactive protein level Decreased sodium and potassium levels

Elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT)

A 17-year-old patient with a family history of alcoholism and depression attends a health clinic for a routine checkup. The patient asks the nurse for suggestions to prevent alcohol abuse in the future. Which recommendation should the nurse make based on the developmental stage of the patient? Determining the extent of their family's history of alcoholism Being aware that the patient may have a higher tolerance to alcohol than do their peers Encouraging the patient to only drink large amounts of alcohol during special occasions Encouraging peer-based environments that do not engage alcohol or drugs

Encouraging peer-based environments that do not engage alcohol or drugs

The client has been hospitalized and is participating in a substance abuse therapy group sessions. On discharge, the client has consented to participate in AA community groups. The nurse is monitoring the client's response to the substance abuse sessions. Which statement by the client best indicates that the client has developed effective coping response styles and has processed information effectively for self use? "I know I'm ready to be discharged. I feel I can say 'no' and leave a group of friends if they are drinking... 'No Problem.'" "This group has really helped a lot. I know it will be different when I go home. But I'm sure that my family and friends will all help me like the people in this group have... They'll all help me... I know they will... They won't let me go back to my old ways." "I'm looking forward to leaving here. I know that I will miss all of you. So, I'm happy and I'm sad, I'm excited and I'm scared. I know that I have to work hard to be strong and that everyone isn't going to be as helpful as you people." "I'll keep all my appointments; go to all my AA groups; I'll do everything I'm supposed to... Nothing will go wrong that way."

"I'm looking forward to leaving here. I know that I will miss all of you. So, I'm happy and I'm sad, I'm excited and I'm scared. I know that I have to work hard to be strong and that everyone isn't going to be as helpful as you people." In the defense mechanism of denial the person denies reality. Option 1 identifies denial. In option 2 the client is relying heavily on others, and the client's focus of control is external. In option 4 the client is concrete and procedure oriented; again the client identifies that "Nothing will go wrong that way" if the client follows all the directions. In option 3 the client is expressing real concern and ambivalence about discharge from the hospital. The client also demonstrates reality in that statement.

The school health nurse is completing an assessment of alcohol use at a rural high school for grades 8-12. Which grade would be impacted the most by a preventive teaching intervention based on the nurse's knowledge of the average age at which young people drink? Grade 10 Grade 11 Grade 8 Grade 12

Grade 8

The police bring a patient to the emergency department after a motor vehicle crash. The patient's blood alcohol level (BAL) is 0.23%. Which symptom of alcohol intoxication is demonstrated at a BAL of 0.20% to 0.25%? Inability to remain upright Clumsiness Ataxia Dysarthria

Inability to remain upright

A patient has completed detoxification from alcohol and is entering a day rehab program. The nurse administers IV naltrexone (ReVia, Depade), an opioid antagonist. Which is the purpose of this medication? It reduces the patient's craving for alcohol. It provides vitamin supplementation for malnourishment. It diminishes anxiety and has anticonvulsant properties. It reduces and controls seizure activity resulting from withdrawal syndrome

It reduces the patient's craving for alcohol.

Select the appropriate interventions for caring for the client in alcohol withdrawal. Monitor vital signs Provide stimulation in the environment Maintain NPO status Provide reality orientation as appropriate Address hallucinations therapeutically

Monitor vital signs Provide reality orientation as appropriate Address hallucinations therapeutically

A patient with Wernicke encephalopathy is admitted with altered consciousness. Which collaborative intervention should be implemented first for this patient? Opioid antagonist Dextrose Thiamine Benzodiazapine

Thiamine