Substance-Related and Addictive Disorders

All states had to conform to the _______ g/dL blood alcohol level (BAL) standard of legal intoxication by 2004 or risk loss of federal highway funding.

0.08 g/dL

A client experiencing alcohol-induced withdrawal is prescribed lorazepam 0.5 mg qid. The physician has ordered a CIWA to be completed every 4 hours. Additional prn lorazepam is based on the following scale: CIWA score of 7 to 12: administer 0.5 mg pf lorazepam. CIWA score of > 12: administering 1 mg of lorazepam. The client's CIWA score at 0400 was 6, at 0800 was 14, at 1200 was 8, at 1600 was 10, at 2000 was 14, and at 2400 was 6. How many milligrams of lorazepam did the client receive in 1 day?

5 mg

A client in treatment for alcohol use disorder enters the ED complaining of head and neck pain, dizziness, sweating, and confusion. BP 100/60 mm Hg, pulse 130, and respirations 26. Which question should the nurse ask to assess this situation further? A) "Are you currently on any medications for the treatment of alcohol use disorder?" B) "How long have you been abstinent from using alcohol?" C) "Are you currently using any illegal street drugs?" D) "Have you had any diarrhea or vomiting?"

A) "Are you currently on any medications for the treatment of alcohol use disorder?"

When alcohol is consumed, what percentage is absorbed immediately into bloodstream through which body organ? A) 20% is absorbed through the stomach wall. B) 30% is absorbed through the small intestine. C) 40% is absorbed through the large intestine. D) 50 is absorbed through the liver.

A) 20% is absorbed through the stomach wall.

An intoxicated client is brought to the emergency department (ED) after spraining an ankle. The client states, "How did I get here? Who brought me to the hospital?" Which is the client most likely experiencing? A) A blackout B) Denial C) Minimization D) Alcohol psychosis

A) A blackout

The following clients are waiting to be seen in the ED. Which client should the nurse assess first? A) A client diagnosed with cocaine use disorder experiencing chest pain. B) An intoxicated client with a long history of alcohol use disorder. C) A client who recently experienced a "bad trip" from lysergic acid diethylamide (LSD). D) A woman who thinks she has been given flunitrazepam (Rohypnol).

A) A client diagnosed with cocaine use disorder experiencing chest pain.

A client with a long history of alcohol use disorder has been recently diagnosed with alcoholic cardiomyopathy. Which correctly written nursing diagnosis would take priority? A) Altered perfusion R/T misuse of alcohol AEB decreased oxygen saturations. B) Altered coping R/T powerlessness AEB chronic alcohol abuse. C) Risk for injury R/T congestive heart failure. D) Activity intolerance R/T decreased perfusion.

A) Altered perfusion R/T misuse of alcohol AEB decreased oxygen saturations.

What classification of drugs share a similar profile of symptoms with alcohol-induced intoxication and alcohol-induced withdrawal? A) Anxiolytics B) Amphetamines C) Cocaine D) Phencyclidine (PCP)

A) Anxiolytics

What situation places an individual at highest risk for mood and behavioral changes related to alcohol consumption? A) At a bar, 180-lb college student drinks four beers in a 1-hour period. B) At a restaurant, a 160-lb woman drinks a glass of wine with a spaghetti dinner. C) At a football game, a 250-lb man drinks three beers with hot dogs. D) A 110-lb woman drinks a margarita with a Mexican combo platter.

A) At a bar, 180-lb college student drinks four beers in a 1-hour period.

Ineffective denial is the nursing diagnosis that is appropriate at this time for a client, diagnosed with alcohol use disorder who has relapsed. What is the priority nursing intervention to address this problem? A) Help the client to analyze the effects of substance abuse on life situations. B) Set up an appointment for follow-up and provide community resources. C) Provide a stimulus-free environment. D) Monitor vital signs.

A) Help the client to analyze the effects of substance abuse on life situations.

A client with a long history of alcohol use disorder presents in the ED with a sudden onset of muscle pain, swelling, and weakness as well as reddish-tinged urine. What laboratory value would the nurse evaluate as evidence of this client's disorder? A) Increase in CPK B) Increase in low-density lipoproteins (LDL) C) Decrease in fasting blood sugar (FBS) D) Decrease in aspartate aminotransferase (AST)

A) Increase in CPK

Which intervention takes priority when dealing with a client experiencing Wernicke-Korsakoff syndrome? A) Monitor parenteral vitamin B1 B) Increase fluid intake C) Provide prenatal vitamins D) Encourage foods high in vitamin C

A) Monitor parenteral vitamin B1

A newly admitted client with a long history of alcohol use disorder complains of burning and tingling sensations of the feet. The nurse would recognize these symptoms as indicative of which condition? A) Peripheral neuropathy B) Alcohol myopathy C) Wernicke's encephalopathy D) Korsakoff's psychosis

A) Peripheral neuropathy

Which is the priority diagnosis for a client experiencing cocaine-induced withdrawal? A) Powerlessness B) Risk for injury C) Ineffective health maintenance D) Ineffective coping

A) Powerlessness

Using the principles of biological theory, what contributing factor puts a client at risk for the diagnosis of alcohol use disorder? A) The client is a child of a parent diagnosed with alcohol use disorder. B) The client is fixated in the oral stage of psychosocial development. C) The client is highly self-critical and has unconscious anxiety. D) The client is unable to relax or defer gratification.

A) The client is a child of a parent diagnosed with alcohol use disorder.

The nurse is working with a 45-year-old client who has abused alcohol since age 20. Related to this client's stage of psychosocial development, what developmental data would the nurse expect to assess? A) The client may have trouble establishing intimate relationships. B) The client may have trouble trusting others. C) The client may review life, have serious regrets, and experience despair. D) The client may feel a sense of inferiority or inadequacy.

A) The client may have trouble establishing intimate relationships.

A nursing student is preparing a thesis on alcohol use disorder. Which facts should be included? A) The prevalence of alcohol use disorder varies within cultural groups. B) More females than males are diagnosed with alcohol use disorder. C) Drinking rates are highest among young adults and accelerate with increasing age. D) Nicotine dependence decreases with increasing levels of alcohol consumption.

A) The prevalence of alcohol use disorder varies within cultural groups.

Which of the following are considered therapeutic elements of 12-step programs such as Alcoholics Anonymous (AA)? Select all that apply. A) 12-step programs break down denial in an atmosphere of support. B) 12-step programs give clients a sense of community. C) 12-step programs help clients recognize the power they have over their addiction. D) 12-step programs provide clients with experts in the field of addiction. E) 12-step programs provide sponsors who acclimate clients back into social settings.

ANS: A, B

Which of the following are parts of the CAGE questionnaire screening tool? Select all that apply. A) Have you ever felt you should cut down on your drinking? B) Have people annoyed you by criticizing your drinking? C) Have you ever felt guilty about your drinking? D) Have you ever had a drink in the morning to steady your nerves? E) Have you ever felt isolated, like you were in a cage?

ANS: A, B, C, D

Which of the following are effective ways to identify a substance-impaired nurse? Select all that apply. A) A nurse who frequently administers medications to other nurses' clients. B) High absenteeism if the substance source is outside of the work area. C) Denial of substance abuse problems. D) A high incidence of incorrect narcotic counts. E) Poor concentration and difficulty in meeting deadlines.

ANS: A, B, C, D, E

Which of the following assessment data should the nurse gather when confirming a diagnosis of alcohol use disorder? Select all that apply. A) Continued alcohol use despite recurrent interpersonal problems. B) Recurrent, alcohol-related legal problems. C) Recurrent alcohol use resulting in failure to fulfill major role obligations. D) A need for markedly decreased amounts of alcohol to achieve a desired effect. E) A disruption in physical and psychological functioning.

ANS: A, B, C, E

Which of the following behaviors are likely to be assessed in the pre-alcoholic phase of drinking progression? Select all that apply. A) Alcohol is used to relieve stressful situations. B) Alcohol is no longer a source of pleasure, but rather a drug that is required by the individual. Blackouts are experienced. C) Control is lost, and physiological dependence is evident. D) The individual is usually intoxicated more than sober, and emotional and physical disintegration occur. E) Tolerance to alcohol begins to develop.

ANS: A, E

Which of the following sociocultural factors increase a client's risk for the diagnosis of alcohol use disorder? Select all that apply. A) The client's twin sister has been diagnosed with alcohol use disorder. B) The client was raised in a home where alcohol use was the norm. C) The client is from a family that culturally accepts the use of alcohol. D) The client experiences pleasure when using alcohol and subsequently repeats the use. E) The client is influenced by morphine-like substances produced during alcohol use.

ANS: B, C, D

A client diagnosed with alcohol use disorder states that his wife complains abut his drinking but stocks his bar with gin. The nurse suspects codependency. Which of the following characteristics would the nurse expect his wife to exhibit? Select all that apply. A) The wife has a long history of egocentric tendencies. B) The wife is a "people pleaser" and would do almost anything to gain approval. C) The wife does not feel responsible for making her husband happy. D) The wife has an accurate understanding regarding her own identity. E) The wife experiences a profound sense of powerlessness.

ANS: B, E

A nursing student is reviewing a client's chart. It is noted that the client is exhibiting signs of a drinking pattern in the early alcoholic phase. Which of the following behaviors would the student expect to note? Select all that apply. A) Use of alcohol as a stress reliever. B) Amnesia that occurs during or immediately after a period of drinking. C) Total loss of control over drinking behaviors. D) Continuous intoxication with few periods of sobriety. E) Secret drinking and preoccupation with drinking and maintaining alcohol supply.

ANS: B, E

A client with a long history of alcohol use disorder recently has been diagnoses with Wernicke-Korsakoff syndrome. Which of the following symptom should the nurse expect to assess? Select all that apply. A) A sudden onset of muscle pain with elevations of creatine phosphokinase (CPK). B) Signs and symptoms of congestive heart failure. C) Loss of short-term and long-term memory and the use of confabulation. D) Inflammation of the stomach and gastroesophageal reflux disorder E) Laboratory values that document severe thiamine deficiency

ANS: C, E

Which of the following statements are true regarding how the body processes alcohol? Select all that apply. A) Alcohol is absorbed slowly after processing through the liver. B) Similar to other foods, alcohol must be digested. C) Rapidity of absorption is influenced by various factors, such as a full stomach. D) Only moments after consumption, alcohol is excreted. E) The body burns alcohol at the rate of about 0.5 ounce per hour.

ANS: C, E

Which of the following nursing statements describe the personality factors that are implicated in the predisposition to a diagnosis of substance use disorder? Select all that apply. A) "Hereditary factors can predispose a client to the diagnosis of substance use disorders." B) "Alcohol produces morphine-like substances in the brain that are responsible for a predisposition to alcohol use disorder." C) "A punitive superego can predispose a client to substance use disorders." D) "A tendency toward addictive behaviors increases as low self-esteem, passivity, and and an inability to relax or defer gratification increase." E) "Fixation at the oral stage of psychosexual development can predispose a client to the diagnosis of substance use disorders."

ANS: D, E

A student nurse is assessing a newly admitted client who suffered a concussion after a driving under the influence (DUI) citation involving crack cocaine. The nursing instructor should recommend which strategy to obtain the most accurate data? A) "It is important to teach the effects of cocaine on the body." B) "After obtaining client permission, validate this information with family members." C) "Accurately record the client's statement related to the quantity of cocaine use." D) "Instruct the client regarding what will happen during the detox process."

B) "After obtaining client permission, validate this information with family members."

What substance stimulates the CNS? A) Vodka B) "Crack" C) Lorazepam D) Triazolam

B) "Crack"

The nurse is planning a teaching session for a client who has recently been prescribed disulfiram as deterrent therapy for alcohol use disorder. What statement indicates that the client has accurate knowledge of this subject matter? A) "Over-the-counter cough and cold medication should not affect me while I am taking disulfiram." B) "I'll have to stop using my alcohol-based aftershave while I am taking the disulfiram." C) "Disulfiram should decrease my cravings for alcohol and make my recovery process easier." D) "Disulfiram is used as a substitute for alcohol to help me avoid alcohol withdrawal symptoms."

B) "I'll have to stop using my alcohol-based aftershave while I am taking the disulfiram."

A client diagnosed with alcohol use disorder is admitted to a substance disorder unit complaining of decreased exercise tolerance, lower extremity edema, arrhythmias, and dyspnea. Which nursing intervention would be appropriate for this client? A) Provide thiamine-rich foods B) Administer ordered digoxin and furosemide C) Reorient the client to person, place, and time D) Encourage high-sodium foods

B) Administer ordered digoxin and furosemide

Three days after surgery to correct a perforated bowel, a client begins to display signs and symptoms of tremors, increased blood pressure, and diaphoresis. What should the nurse suspect? A) Concealed hemorrhage B) Alcohol or other central nervous system (CNS) depressants- induced withdrawal C) Malignant hyperpyrexia D) Neuroleptic malignant syndrome

B) Alcohol or other central nervous system (CNS) depressants- induced withdrawal.

Which drug would a nurse recognize as appropriate in assisting a client with recovery from long-standing heroin use disorder? A) Acamprosate calcium B) Buprenorphine/naloxone C) Disulfiram D) Haloperidol

B) Buprenorphine/naloxone

A client on the substance use disorder unit states, "I used to be able to get a 'buzz on' with a few beers. Now it takes a six-pack." How should the nurse, in the role of a teacher, address this remark? A) By assessing the client's readiness for learning and reviewing the criteria for alcohol-induced withdrawal. B) By explaining the effects of tolerance and telling the client that this is a sign of alcohol use disorder. C) By presenting the concept of minimization and how this affects a realistic view of the problems precipitated by alcohol use disorder. D) By confronting the client with the client's use of the defense mechanism of rationalization.

B) By explaining the effects of tolerance and telling the client that this is a sign of alcohol use disorder.

A client on an inpatient psychiatric unit is overheard stating, "I blew some snow yesterday while I was out on a pass with my family." What would the nurse expect to assess as a positive finding in this client's urine drug screen? A) Amphetamines B) Cocaine C) Barbiturates D) Benzodiazepines

B) Cocaine

A client admitted for chest pain related to cocaine use disorder states, "This is nothing but a little indigestion. What is all the fuss about?" This client is using which defense mechanism? A) Minimization B) Denial C) Rationalization D) Projection

B) Denial

A client with a long history of alcohol use disorder is showing signs of cognitive deficits. What drug would the nurse recognize as appropriate in assisting with this client's alcohol recovery? A) Disulfiram B) Naltrexone C) Lorazepam D) Methadone

B) Naltrexone

Which nursing intervention is appropriate for a client who has a nursing diagnosis of risk for injury R/T alcohol-induced withdrawal? A) Monitor fluid intake and output. B) Provide the client with a quiet room free from environmental stimuli. C) Teach the client about the effects of alcohol on the body. D) Emphasize with the client but confront denial.

B) Provide the client with a quiet room free from environmental stimuli.

A client has been diagnosed with Wernicke-Korsakoff syndrome. Which describes this client's use of confabulation? A) The client has difficulty keeping thoughts focused and on topic. B) The client clearly discussed a field trip, when in reality no field trip occurred. C) The client jumps from one topic to another. D) The client lies about anxiety level rating to receive more anxiolytics.

B) The client clearly discussed a field trip, when in reality no field trip occurred.

A client is admitted to the ED and is tested for BAL. The client has a BAL of 0.10 g/dL. What is an accurate interpretation of this laboratory value? A) The client is within the legal limits of BAL. B) The client is assessed as legally intoxicated. C) The client would be considered intoxicated depending on state laws. D) The client must perform other psychomotor tests to determine intoxication.

B) The client is assessed as legally intoxicated.

A client who is exhibiting symptoms of alcohol-induced withdrawal is admitted to the substance abuse unit for detoxification (detox). One of the nursing diagnoses for this client is ineffective health maintenance. Which is a correctly written long-term outcome for this nursing diagnosis? A) The client will agree to attend nutritional counseling sessions. B) The client will exhibit reduced medical complications related to alcohol use disorder within 6 months. C) The client will identify at least three effects of alcohol on the body by day two of hospitalization. D) The client will remain free from injury while withdrawing from alcohol.

B) The client will exhibit reduced medical complications related to alcohol use disorder within 6 months.

The nurse has given a client information on alcohol use disorder recovery. Which client statement indicates that learning has occurred? A) "Once I have detoxed, my recovery is complete." B) "I understand that the goal of recovery is to decrease my drinking." C) "I realize that recovery is a lifelong process that comes about in steps." D) "Al-Anon can assist me in my recovery process."

C) "I realize that recovery is a lifelong process that comes about in steps."

The nurse is caring for a client on an inpatient substance use disorder unit. Because of the client's alcohol abuse, the client has lost family, job, and driver's license. What phase of drinking pattern progression is this client experiencing? A) Prealcoholic phase B) Early alcoholic phase C) Crucial phase D) Chronic phase

C) Crucial phase

A client with a long history of alcohol use disorder comes to the ED with frank hemoptysis. Which life-threatening complication of this disorder is the client experiencing, and what is the probable cause? A) Hepatic encephalopathy resulting from the inability of the liver to convert ammonia to urea for excretion. B) Thrombocytopenia resulting from the inability of the diseased liver to produce adequate amounts of prothrombin and fibrinogen. C) Hemorrhage of esophageal varices resulting from portal hypertension. D) Ascites resulting from impaired protein metabolism.

C) Hemorrhage of esophageal varices resulting from portal hypertension

A client who has recently relapsed from alcohol abstinence is seen in the outpatient mental health clinic. The client states, "I don't know what all the fuss is about. Can't I have a few drinks now and then?" Which nursing diagnosis applies to this client? A) Risk for injury B) Risk for violence: self-directed C) Ineffective denial D) Powerlessness

C) Ineffective denial

A client receives lorazepam because of high Clinical Institute Withdrawal Assessment (CIWA) score. What is the rationale for this pharmacological intervention? A) Lorazepam is a medication that decreases cravings in clients who are experiencing alcohol-induced withdrawal. B) Lorazepam is a deterrent therapy that helps to motivate clients to maintain alcohol abstinence. C) Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms. D) Lorazepam is a CNS stimulant that decreased the CIWA score.

C) Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms.

A client currently hospitalized for the third alcohol detox in 1 year believes relapses are partially due to an inability to control cravings. Which prescribed medication would meet this client's need? A) Buspirone B) Disulfiram C) Naltrexone D) Lorazepam

C) Naltrexone

Which is true about the outcomes of nursing interventions for clients experiencing a substance use disorder? A) Outcomes should be based on guidelines documented and listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). B) Outcomes are set by the North American Nursing Diagnosis Association (NANDA). C) Outcomes should be tailored to the individual's immediate needs and abilities. D) Outcomes should return the client to the highest level of wellness.

C) Outcomes should be tailored to the individual's immediate needs and abilities.

When the nurse is planning relapse prevention strategies for clients diagnosed with substance use disorders, which should be the initial nursing approach? A) Address previously successful coping skills. B) Encourage rehearsing stressful situations that may lead to relapse. C) Present information simply, using easily understood terminology. D) Provide numerous choices of community resources.

C) Present information simply, using easily understood terminology.

Which is the priority diagnosis for a client experiencing alcohol-induced withdrawal? A) Ineffective health maintenance B) Ineffective coping C) Risk for injury D) Dysfunctional family processes: alcohol use disorder

C) Risk for injury

The nurse is educating a client about how to avoid sources of stimulation. What substance produces the least significant stimulation to the CNS? A) Brewed coffee B) Excedrin Migraine C) Tequila shooter D) Filtered cigarettes

C) Tequila shooter

A fasting blood glucose level value is to a sliding scale insulin dosage as a CIWA score is to: A) An olanzapine dosage B) A lithium carbonate dosage C) A fluoxetine dosage D) A lorazepam dosage

D) A lorazepam dosage

A nurse on an inpatient psychiatric unit assesses a client after visitation hours. The nurse documents the assessment data and reviews the client's medical record. Which nursing intervention is most important? -Assessment info: pupils contracted, small, confused, slurred speech, pale, clammy, sleepy, difficult to awake, disoriented, BP 80/50, resp 12, CIWA =5, pulse 46 bpm, irregular -Medications: Ativan 0.5 mg prn, Naloxone 2 mg IM prn, Tylenol 500 mg prn -Lab results: UDS + opiates, alcohol A) Contact the family to inquire about past and current drug use. B) Administer lorazepam to assist the client with alcohol-induced withdrawal. C) Recheck vitals and stay with the client to build rapport and trust. D) Administer naloxone 2 mg IM due to apparent overdose of opiates.

D) Administer naloxone 2 mg IM due to apparent overdose of opiates.

A client with a history of alcohol use disorder complains of extreme muscle pain, swelling, and weakness of extremities, and reddish-tinged urine. what laboratory value related to these symptoms would the nurse expect to assess? A) An elevated gamma-glutamyl transferanse (GGT). B) An elevated enzyme-linked immunosorbent assay (ELISA). C) An elevated white blood cell count (WBC). D) An elevated CPK.

D) An elevated CPK.

A client with a history of alcohol use disorder is seen in the ED 2 days after a binge of excessive alcohol consumption. The nurse suspects pancreatitis. Which symptoms would support the nurse's suspicion? A) Confusion, loss of recent memory, and confabulation. B) Elevated CPK with congestive heart failure symptoms. C) Paralysis of the ocular muscles, diplopia, and ataxia. D) Constant, severe epigastric pain; nausea and vomiting; and abdominal distention.

D) Constant, severe epigastric pain; nausea and vomiting; and abdominal distention.

A client diagnosed with a substance use disorder states to the nurse, "My wife causes me to abuse methamphetamines. She uses and expects me to." This client is using which defense mechanism? A) Rationalization B) Denial C) Minimization D) Projection

D) Projection

Which is the priority nursing diagnosis for a client experiencing alcohol-induced intoxication? A) Pain B) Ineffective denial C) Ineffective coping D) Risk for aspiration

D) Risk for aspiration

A client is admitted for benzodiazepine use disorder detox. This is the client's fourth detox, and the client's third detox was considered complicated. What would determine the nurse's priority intervention at this time? A) The nurse must use confrontation because the client will use defense mechanisms such as denial, projection, and displacement to protect ego strength. B) The nurse must provide empathetic support because the client will have little family support as a result of behaviors influenced by substance use disorder. C) The nurse must present the consequences of the client's actions because the client will have little motivation for change. D) The nurse should monitor the client closely and initiate seizure precautions because the client will be at high risk for seizures.

D) The nurse should monitor the client closely and initiate seizure precautions because the client will be at high risk for seizures.