Fortinash Chapter 19: Substance-Related Disorders and Addictive Behaviors

Which nursing intervention best demonstrates an understanding of the relationship between confirmed intravenous drug abuse and specific infections? a. Screening the patient for hepatitis B virus (HBV) b. Assessing the patient for potentially infected injection sites c. Determining if the patient has ever been tested for human immunodeficiency virus (HIV) d. Evaluating the patients understanding of the increased risk for developing sexually transmitted diseases

A (Injecting drug users have one of the highest HBV rates among all risk groups and account for at least half of all new HCV cases, so screening for such infections demonstrates that the nurse understands the severity of the problem. Although the other options reflect potential infection risks, they are not as commonly seen in patients with this diagnosis.)

Which question is most appropriate when assessing a patient who is exhibiting symptoms of a systemic infection including a fever of unknown origin? a. Are you an intravenous drug user? b. Have you been told that you drink too much alcohol? c. Have you been diagnosed with an acute bacterial infection before? d. Are you familiar with an infection of the heart called endocarditis?

A (Intravenous drug users are at risk for subacute bacterial endocarditis and other circulatory compromise created by foreign substances introduced during the process of intravenous use. Regardless of the setting, nurses need to ask about intravenous drug use whenever a patient presents with fever of unexplained origin. Assessing the patients knowledge related to bacterial infections and endocarditis will not address the possible cause of the fever. Alcohol consumption is not relevant in this situation.)

When asked, What causes alcoholism? the nurses response will be based on the fact that: a. The response to alcohol is a result of a brain-based disorder. b. Alcoholism is believed to be an allergic response to the alcohol. c. Every individual has the same susceptibility for developing alcoholism. d. It is a physical response to alcohol but its etiology is not fully understood.

A (It has been determined that alcoholism is not an allergy but rather it is recognized as a partial brain-based disorder that some brains are more susceptible to than others.)

A substance use disorder (SUD) is a likely comorbid mental illness in which patient? a. The soldier diagnosed with posttraumatic stress disorder b. The teenager demonstrating symptoms of poor impulse control c. The older adult diagnosed with early stage Alzheimers disease d. The new mother exhibiting symptoms of postpartum depression

A (Posttraumatic stress disorder creates a risk for substance use or relapse. A total of 30% to 60% of persons with SUDs meet the criteria for comorbid posttraumatic stress disorder. The remaining options have not shown such a prevalence of comorbid relationship with SUDs.)

A patients wife has chronic alcoholism, and the husband is concerned about the possibility that their children may develop the disease. He asks the nurse what the risk is. The nurses best response is: a. The risk for developing alcoholism is increased if there is a family history of alcoholism. b. Studies have confirmed that individuals with dependent personality traits are at high risk for this disease. c. Cultures that include alcohol as part of the ritualized behavior have a higher rate of alcoholism. d. Twin studies have indicated that the environment of a person is more important than the biologic influences of parents.

A (Problems with alcohol increase with the number of relatives with alcoholism. No unique personality profile is prone to addiction. Ritualized use of alcohol does not predispose to alcoholism and twin studies indicate a significant genetic contribution to susceptibility to alcoholism.)

Which protocol should guide the nurse responsible for administering pharmacologic interventions for a patient who is experiencing alcohol intoxication? a. Medication interventions are based on the presence of withdrawal symptoms. b. Medications are prescribed at appropriate intervals for at least one full week. c. Symptoms are managed with medications for only the initial 24 hours of hospitalization. d. Medications are introduced to treat grand mal seizures that may accompany withdrawal symptoms.

A (The course of intoxication is usually self-limiting to approximately 24 hours, after which withdrawal symptoms can occur for a time period unique to each patient. Treatment is directed by the symptoms the patient is experiencing, which generally emerge during the withdrawal stage. Seizures are among several serious symptoms that can occur during the withdrawal stage.)

Which group would be the target population for educational material on the dangers of binge drinking? a. Full-time college students b. Blue-collared young adults c. Older widows and widowers d. High school juniors and seniors

A (The highest prevalence of binge and heavy drinking is among young adults between the ages of 18 and 25 years, with the majority being full-time college students.)

Which outcome would be appropriate for the detoxification phase of treatment for alcoholism? a. Adequate dietary protein intake b. Re-connection with family and support system c. Identification of triggers that cause alcohol abuse d. Control over emotions resulting in aggressive behavior

A (When implementing any plan, patient safety and health are always the first priorities, so the nurse focuses on nutritional support, including providing a protein-rich diet. The remaining options are outcomes reserved for the later stages of the recovery process.)

A teen says to the school nurse, Huffing is harmless. There are no reasons not to sniff inhalants. The nurse can reply knowing that (select all that apply): a. Such behavior can result in irreversible hearing impairment. b. There has been minimal research done on the effects in teens. c. Long-term use can result in poor short- and long-term memory. d. Irreversible kidney damage is often observed with even casual use. e. Research indicates both central nervous system and bone marrow damage.

A, C, E (Research as shown that even teens who engage in sniffing high concentrations on inhalants often experience hearing loss, CNS and bone marrow damage, and impaired cognitive function. Kidney impairment is often seen as reversible.)

When suspicious of possible fetal alcohol syndrome, which assessment findings would support this diagnosis? Select all that apply. a. Webbed toes b. An enlarged head c. Super sensitive hearing d. A flattened bridge of the nose e. Symptoms of a septal heart defect

A, D, E (The correct options are characteristics of FAS but one would not include hearing loss or a small head in children with this disorder.)

Which observation best supports the patients success with achieving long-term sobriety? a. Asking a family member to, get rid of all the alcohol before I come home b. Identifying all the problems alcoholism has caused the family over the years c. Being able to discuss the importance of attending a support group for alcoholics d. Promising to, stop the drinking so I can be a good parent and raise a good child

B (One of the most prominent factors that leads an individual to recovery is the patients recognition that substance use has caused or influenced his or her lifes problems and interrupted his or her functioning. The remaining options lack that element of self-reflection.)

Which sociological aspect, vital to relapse prevention, is greatly affected when a patient is found to have a dual diagnosis of psychosis and alcoholism? a. Ability to afford the cost of outpatient services b. A supportive, reliable, accessible support system c. Protection from both physical and emotional abuse d. Access to reasonable housing and employment opportunities

B (Often individuals with this type of diagnosis have lost their support systems as a result of chronic mistreatment of their family and friends and an inability to maintain and recognize the importance of this aspect to their treatment plan. Although the remaining options impact relapse prevention, they are generally available when the patient is being supported appropriately.)

A nurse engaged in primary prevention for substance abuse among adolescents could advise parents to (select all that apply): a. Watch for signs of depression. b. Help the teen anticipate pressures. c. Be a role model for effective coping skills. d. Support the teens interest in hobbies and sports. e. Require academic tutoring when grades begin to drop.

B, C, D (The correct options are proactive and focus on preventing the problem although the remaining options intervene once there are indications that the problem may exist.)

Which behaviors would demonstrate a strong possibility for successful rehabilitation for a patient with a substance abuserelated diagnosis? Select all that apply. a. States that, I promise Ill never use drugs again. b. Has shown ability to use effective coping mechanisms c. Expresses an understanding of the severity of their addiction d. Plans to associate with old friends only when they arent drinking e. Demonstrates an interest in staying involved in an appropriate support group

B, C, E (The correct options show an understanding of the disease process and examples of needed skills as well as the commitment to maintain control over their addiction. The remaining options reflect promises but not true insight into the severity of their problem and the effects needed to manage it successfully.)

If an individual is admitted with a diagnosis of Wernicke-Korsakoffs syndrome, the nurse would expect to assess: a. Peptic ulcer b. Vivid illusions c. Cognitive deficits d. Auditory hallucinations

C (Wernicke-Korsakoffs syndrome includes a severe form of amnesia and an inability to learn new skills which reflects a cognitive impairment. The other options are not associated with the syndrome.)

Which patient response would support the conclusion that the patient has moved into the dark side of a narcotic addition? a. Ive been abusing drugs for at least 10 years. b. Drugs makes me feel good; that why I use them. c. I dont like the way I feel when I dont use drugs. d. Drugs are something that I can either take or leave

C (During beginning use (the light side), the feel good effects are dominant. As the individual becomes habituated to the drug, tolerance and withdrawal symptoms develop; this constitutes the dark side. The remaining options do not describe effects of drug use.)

Which nursing intervention demonstrates an understanding regarding the primary form of substance use disorder among older adults? a. Assessing the patients hands and feet for the presence of both numbness and tingling b. Having the patient, describe your relationship with you adult children, co-workers, and friends. c. Asking, Please identify for me all the medications both prescribed and over the counter you regularly take. d. Evaluate the patients understanding of the possible health risks that alcohol and medication abuse has on ones health

C (Misuse of prescription medications is the most common form of drug abuse among older adults. This population is especially vulnerable because of the multiple drugs that are often prescribed for medical conditions. The remaining options do not help identify the presence of multiple medications.)

Which assessment data would bring into question a patients statement that, I have only a few drinks on special occasions.? a. History of treatment for glaucoma b. Fasting serum blood glucose level of 182 mg/dL c. Patient reports numbness in hands and feet bilaterally d. Red rash observed over neck, shoulders, and upper chest

C (Peripheral nerve deterioration in both hands and feet result from chronic alcohol intake. Peripheral neuropathy occurs in about 10% of alcoholics after years of heavy drinking causing the nurse to question the patients statement. The remaining options do not reflect symptomology generally associated with alcoholism.)

A patient recently discharged from an alcohol rehabilitation program is brought to the hospital in a state of prostration with severe throbbing headache, tachycardia, a beet-red face, dyspnea, and continuous vomiting. The patients significant other states the patient got sick about 15 minutes after drinking a glass of wine. The nurse should be guided in assessment by the suspicion that the patient: a. Is having a stroke b. Has alcohol intoxication c. Is reacting to disulfiram (Antabuse) d. Is exhibiting symptoms of cross-dependence

C (The alcohol deterrent drug, Antabuse, commonly prescribed in recovering alcoholic treatment, causes this reaction when taken in combination with alcohol. Alcohol intoxication, stroke, and cross-dependence do not present with the listed prostration symptoms.)

Which assessment data poses the greatest risk for injury in a patient who abuses alcohol? a. Takes a baby aspirin each morning b. Uses over-the-counter antihistamines for seasonal allergies c. Has been taking a tricyclic antidepressant for more than 2 years d. Took a narcotic for 1 week to manage postdental surgery pain

C (Tricyclic antidepressants are strictly contraindicated with alcohol consumption because of their potential effect on cardiac function. Although aspirin increases bleeding times and antihistamines and narcotics increase sedation, the outcome of combining alcohol and these drugs is not as dangerous as that of the correct option.)

Which intervention will the nurse plan for when managing the detoxification of a patient diagnosed with chronic alcoholism? a. Low-protein diet to minimize risk of kidney failure b. Seclusion to help manage aggression towards others c. Transporting patient to scheduled 12-step support group meetings d. Administering Ativan (lorazepam) to manage alcohol withdrawal symptoms

D (During the process of detoxification, the nurse gives enough of a drug (or one to which the person has cross-tolerance) to relieve the withdrawal symptoms. Benzodiazepines like lorazepam (Ativan) have a cross-tolerance with alcohol, so they are used to manage withdrawal symptoms. The detoxification diet would be high in protein. Seclusion would not be initiated before less severe attempts to manage the behavior failed. Attending a support group would not be appropriate for the detoxification stage of rehabilitation.)

Which observation seen in a teenage patient supports the suspicion of anabolic steroid abuse? a. Lack of facial hair b. Ritualized hand washing c. Stealing and hiding a magazine belonging to another patient d. Throwing a chair when told it was time to turn off the television

D (For all individuals abusing anabolic steroids, extreme mood swings occur, and these may be accompanied by violent behaviors. Obsessive-compulsive behaviors and stealing are not generally associated with this disorder. The increased hormone presence would result not in a lack, but rather an increase, in facial hair.)

Which intervention has priority when a nurse suspects a staff member of providing patient care while being impaired by alcohol or drugs? a. Asking the staff member to explain their suspicious behavior b. Adjust the staff members assignment to minimize patient contact c. Providing the staff member with material regarding alcohol abuse and treatment d. Reporting the staff members suspicious behavior to the nursing supervisor on duty

D (It is a professional obligation to report suspected impaired practice. The remaining options do not have prior in this situation since the concern is patient safety.)

Which intervention will the nurse caring for a patient suspected of phencyclidine (PCP) abuse implement based on an understanding of the medications unique properties? a. Assessing for chronic renal failure b. Focusing attention on providing patient safety c. Implementing suicide precautions immediately d. Monitoring for delayed development of psychotic symptoms

D (Phencyclidine (PCP) is a hallucinogen, but it has its own set of CNS reactions. PCP has a long duration of action that can result in delayed psychotic symptoms. Chronic renal failure would not be immediately observable. Patient safety is a nursing responsibility regardless of the diagnosis. Self-harm is not generally a characteristic of this type of substance abuse.)

Which principle of recovery is the basis of the nurses response when a patient relapses and is hospitalized for alcohol detox treatment? a. Alcoholism requires a lifelong commitment to control. b. Most people who are serious about treatment achieve sobriety. c. Relapsing is an expected occurrence for the patient diagnosed with alcohol abuse. d. Rehabilitation generally involves several relapses before true sobriety is achieved.

D (Sobriety is the goal of complete abstention from drugs, alcohol, and addictive behaviors. Sobriety often involves several attempts, and many patients relapse 9 or 10 times before achieving and sustaining sobriety. This information is the basis for the physical and emotional support provided by the nurse. Although citing that a relapse is not a failure but an expected part of the recovery process, this option does not include the needed information of the frequency of the possible relapses. The remaining options are not focused on relapsing.)

Which assessment demonstrates the nurses understanding of the relationship between substance abuse and the development of symptoms characteristic of delirium? a. Determining the patients age and gender b. Evaluating the patients food and fluid intake over the last 48 hours c. Observing the patient for fine tremors of the hands, especially the fingers d. Determining the amount of caffeine the patient ingested in the last 24 hours

D (Some people who ingest large amounts of caffeine develop delirium. The remaining options are not relevant to caffeine ingestion or the abuse of any other substance.)

Which assessment observation is the best support for a patients diagnosis of alcoholism? a. Reporting, I messed up three marriages. b. Testing positive for hepatitis B virus (HBV) c. Admission that, I drink more than I should. d. A positive response to three items on the CAGE test

D (The CAGE questionnaire is a well-validated screening instrument. A positive response to two of the four items of the CAGE questionnaire indicates a potential problem with alcoholism. Although the remaining options are recognized red flags for possible alcoholism, they lack the selectivity of the screening tool.)

Which social factor has the greatest impact on the changing nature of alcohol abuse treatment? a. Development of new pharmaceutical treatment options b. Dramatic increase of alcoholism among young adult males c. Raising cost of both inpatient and outpatient treatment programs d. Womens substance abuse only recently acknowledge by society

D (The existence of an alcohol abuse problem among women has only been recently recognized and this has dramatically affected treatments and services being provided. Although the other options are true, they do not have the impact on treatment modalities as much as the correct option.)

Which factor has the greatest negative impact on the use of laboratory serum alcohol results in determining legal intoxication? a. The variable time it takes to metabolize alcohol in the body b. States differs greatly in their definitions of legal intoxication c. Legal issues with securing consent for the test from an impaired patient d. The relatively short period of time alcohol can be detected in the blood

D (The major disadvantage of blood alcohol testing is the narrow window of time for the detection of drugs in the blood stream. Although the variability of individual metabolism rates may be considered a factor, they are stable enough to allow for testing timetables. The legal issues related to consent and the definition of legal intoxication limits does not impact the reliability of the test itself to determine intoxication.)