Chapter 95 Substance Use Disorders
Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech
D
Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery. b. Develop a peer support system. c. Develop alternate coping strategies. d. Achieve physiologic stability.
D
Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel) b. Disulfiram (Antabuse) c. Methadone (Dolophine) d. Naltrexone (ReVia)
D
Many substance abusers use defense mechanisms to cope with their stress. Which of the following are most pertinent to substance abuse? Select all that apply. A) Denial B) Rationalization C) Reaction formation D) Displacement E) Projection F) Sublimation
A, B, E
The nurse is caring for a client who has overdosed using cocaine. Which of the following symptoms should the nurse monitor for this client? Select all that apply. A) Hemorrhage B) Seizures C) Hypothermia D) Regular heart beat E) Abnormal respirations F) Joint pain
A, B, E
A heroin-dependant client is undergoing a methadone maintenance program. What interventions should the nurse perform when caring for this client? A) Administer 200 mg as methadone tablets. B) Mix the powder with 120 mL of orange juice. C) Take regular blood samples of the client for analysis. D) Prevent the client from interacting with others.
B
The nurse is caring for recovering alcoholics in a treatment center. Which of the following nursing diagnoses would be considered highest priority? A) High Risk for Violence: Self-Directed or Directed at Others B) Self-Care Deficit C) Self-Esteem Disturbance D) Altered Nutrition: Less Than Body Requirements
A
A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids
B
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
Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Stimulating and colorful c. Active and bright d. Confrontational and challenging
A
A nurse is caring for a 30-year-old client who has been involved in a drunken driving accident. Which of the following is the permitted maximum legal level of blood alcohol content when driving? A) 0.1 g/dL B) 0.3 g/dL C) 0.4 g/dL D) 0.5 g/dL
A
A nurse is gathering data from a client suspected to be an alcohol abuser. Which of the following questions are very important in terms of predicting withdrawal? A) Ask the time when the client had a last drink. B) Ask what type of beverages are used by the client. C) Ask if alcohol has been combined with any other drug. D) Ask for details regarding the amount of beverage consumed.
A
A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine - National Research Council (IOM) c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine
A
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.Introjection c.Projection d.Rationalization
A
At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as: a. codependence. b. role reversal. c. assertiveness. d. homeostasis.
A
During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."
A
Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive b. Cool, distant c. Skeptical, guarded d. Confrontational
A
Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.
A
Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, "I know I need long-term treatment." b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.
A
The nurse counseling clients with chemical abuse discusses the warning signs with their families. Which of the following is a sign of chemical abuse? A) Recurrent use-related legal problems B) Need for more of the drug to cause intoxication C) Withdrawal symptoms occur when the client stops using the drug D) Client cannot stop using the drug
A
The nurse is caring for a client in the emergency department who was using alcohol and does not appear intoxicated. What breathalyzer test result would indicate that this person has alcohol dependence? A) 0.09 g/dL B) 0.3 g/dL C) 0.4 g/dL D) 0.5 g/dL
A
The nurse is caring for a client who is experiencing acute tremulousness caused by alcohol withdrawal. Which of the following would be the drug of choice for this condition? A) 10 to 30 mg oxazepam (Serax) B) 0.5 to 2 mg lorazepam (Ativan) C) 2 to 10 mg diazepam D) 5 to 25 mg chlordiazepoxide (Librium)
A
The nurse is caring for a client who is taking disulfiram (Antabuse) as aversion therapy to maintain sobriety. What is the correct dosage for this medication? A) 500 mg/day for 2 weeks, followed by a daily maintenance dose of 250 mg B) 750 mg/day for 4 weeks, followed by a daily maintenance dose of 250 mg C) 250 mg/day for 2 weeks, followed by a daily maintenance dose of 125 mg D) 500 mg/day for 4 weeks, followed by a daily maintenance dose of 250 mg
A
The nurse is caring for a client who is undergoing unmanaged alcohol withdrawal. Which of the following is a sign or symptom of the autonomic hyperactivity stage of this process? A) Tremors B) Panic C) Hallucinations D) Seizures
A
The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.
A, C, E
The nurse is working with a healthcare team to treat clients with substance abuse. Which of the following accurately describes a step in the management of this condition? A) The addicted person must be the one to recognize the problem to initiate therapy. B) Active interventions must occur; if no one intervenes, the addiction usually continues. C) Treatment of addiction responds best to unstructured therapy. D) Very few recovered chemically dependent people are able to lead a productive life.
B
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
A nurse at the detoxification center is assigned to identify and prepare a data record of a client with a history of alcohol abuse. Which of the following evaluation tools is specific to alcohol abuse identification? A) Addiction Severity Index B) Diagnostic Interview Schedule C) Blood Toxicology Screen Test D) Urine Toxicology Test
B
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
A nurse caring for a client who is undergoing withdrawal from alcohol and is severely malnourished is careful to prevent refeeding syndrome. Which of the following nutrients cause this condition when introduced into the starving person's system too quickly? A) Protein B) Carbohydrates C) Vitamin C D) Fats
B
A nurse is caring for a client suspected of mescaline abuse at the detoxification center. Which of the following symptoms may confirm the abuse of mescaline? A) Lacrimation B) Macropsia C) Diaphoresis D) Dementia
B
A nurse is caring for an intoxicated alcoholic client admitted to the emergency department. Which of the following interventions is most important when caring for the client? A) Touch and calm the client frequently. B) Monitor the level of consciousness of the client. C) Monitor the client for an increase in respiratory rate. D) Encourage the client to watch television.
B
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
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
A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."
B
A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes: a. cross-tolerance. b. substance addiction. c. substance abuse. d. substance intoxication.
B
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
Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.
B
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 nurse is caring for a client undergoing stage 3 of the alcohol withdrawal process. The client complains of "bugs crawling all over my skin." This is a manifestation of what withdrawal symptom? A) Delirium tremens B) Alcohol hallucinosis C) Blackouts D) Tweaking
B
The nurse is counseling a client who is in the intermediate stage of being addicted to cocaine. Which of the following would be a typical response to the question, "Why do you use cocaine?" A) "I use it to feel better." B) "I use it to keep from feeling bad." C) "I use it to have fun with my friends." D) "I use it because I am afraid of losing control."
B
The nurse is counseling the "enabler" spouse of an alcoholic. Which of the following is a nursing consideration for this client? A) In many cases, preventing crises and shielding the alcoholic solves the problem. B) Enablers must understand that alcoholics have a bad disease but are not bad people. C) Enablers must realize that alcohol abusers will stop if they stop enabling them. D) Enabling can prevent a life-threatening condition from progressing.
B
The school nurse is teaching adolescents about the danger of chemical dependency. Which of the following would the nurse use as a teaching point? A) Chemical dependency can lead to diabetes mellitus. B) Chemical dependency can lead to various mental disorders. C) Chemical dependency is based on direct biological transmission. D) High self-esteem is often considered the most potent precipitating factor.
B
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
A 45-year-old male client who is addicted to barbiturates reduces his intake of the drug. For which of the following conditions is the client at risk? A) Hallucinations B) Tremors C) Overdose D) Alcohol abuse
C
A nurse is caring for a client who is a methamphetamine abuser. The nurse observes rapid eye movements and jerky body movements in the client. How should the nurse document this condition of the client? A) Formication B) Delirium C) Tweaking D) Hallucinosis
C
A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.
C
A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.
C
An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect: a. a schizophrenic episode. b. opium intoxication. c. hallucinogen ingestion. d. cocaine overdose.
C
An alcoholic client has been consuming excessive amounts of cola and chocolate. The healthcare provider advises against disproportionate use of over-the-counter preparations containing caffeine. What should the nurse tell the client about the effect of caffeine in the body? A) Causes extreme sleepiness B) Leads to respiratory depression C) Adds to the depressive effect of alcohol D) Decreases the volume of urine
C
The nurse is caring for a client who is withdrawing from amphetamines. Which of the following is the important initial nursing intervention for this client? A) Manage nausea and vomiting B) Initiate suicide precautions C) Perform liver function tests. D) Administer vitamins, as ordered.
C
The nurse is caring for an alcoholic admitted to the hospital who is in unmanaged withdrawal. Which of the following is a nursing consideration for this client? A) Remember that acute detoxification is usually completed in 24 hours. B) Watch for acute detoxification beginning within 36 hours of last ingestion. C) Follow suicide precautions because suicide risk increases during detoxification. D) Keep the client NPO for the first 48 hours to avoid refeeding syndrome.
C
The nurse should be alert for signs and symptoms of CD or withdrawal in all clients. Which of the following is a characteristic of a chemically dependent person? A) All chemically dependent people display the usual stereotype. B) Most chemically dependent people are forthcoming about their addiction. C) Abusers of one drug may have built up tolerance to related drugs. D) Up to 25% of clients receiving care for general conditions have underlying CD.
C
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
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
A nurse at the detoxification center is caring for a severely malnourished client with a history of chronic alcohol abuse. Which of the following nursing care measures should be employed when caring for the client during the time of withdrawal? A) Provide high-calorie, carbohydrate-rich food to the client. B) Encourage the client to drink only water. C) Avoid the joint administration of electrolytes and intravenous fluids. D) Position the client on the side if the client has vomiting or nausea.
D
A nurse is caring for a client with Wernicke-Korsakoff syndrome. The nurse observes rapid eyeball movement from side to side. What term should the nurse use to document rapid eyeball movement from side to side in the client? A) Delirium tremens B) Palmar erythema C) Spider angioma D) Horizontal nystagmus
D
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
A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."
D
A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Barbiturates c. Heroin d. Amphetamines
D
A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. 1-week detoxification program b. 12-step self-help program c. Long-term outpatient therapy d. Residential program
D
Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search and destroy tactics to keep the home alcohol free." c. "It's important that you visit your family member on a regular basis." d. "Make your loved one responsible for the consequences of behavior."
D
The emergency department nurse is caring for an intoxicated alcoholic client who needs stitches following a motor vehicle accident. Which of the following is an appropriate nursing intervention for this client? A) Use restraints if the client is combative. B) Touch the client often to reassure him or her. C) Give the client some alone time to stabilize emotionally. D) Remember that an injury can precipitate withdrawal symptoms.
D
The nurse is assisting the healthcare team to provide dialectical behavioral therapy for a client who is an alcoholic. Which of the following is the focus of this type of therapy? A) An individual's values and beliefs control behavior. B) Each person possesses inborn (inner) health capacity or ability to lead a healthy life. C) Treatment programs for families are conducted simultaneously with the client treatment. D) The "wise mind", a midway point between being totally rational and totally emotional.
D
The nurse is caring for a 35-year-old woman who has built up alcohol tolerance. Which of the following is a nursing consideration appropriate for this client? A) Many painkillers will have a more potent effect on the client. B) The client will become intoxicated slower than male counterparts. C) The use of the antacid Zantac slows the absorption of alcohol. D) The use of aspirin enhances the absorption of alcohol.
D
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