Chapter 17 Substance Abuse
The nurse is co-leading a family therapy group for patients and families of drug addicted individuals. The family of a cocaine addict is angry and can't understand why the patient can't just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. The nurse evaluates an accurate understanding in which of the following statement? (Select all that apply) A) It is a medical illness that is progressive B) The patient will eventually be cured C) Relapses and remissions are part of the illness D) Patients can learn to get control over the substance
A,C
When interviewing the family members of a client being treated for substance abuse problems, which of the following behaviors would alert the nurse to the possibility of codependency? A) Being flexible but angry B) Blaming themselves for the family's problems C) Expressing thoughts and feelings openly D) Taking pleasure in self-accomplishments
B
A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which of the following statements would indicate that teaching has been effective? A) "Antabuse is safe to take with any over-the-counter cold medication." B) "Antabuse will block my cravings for alcohol so I'll have less desire to drink." C) "Drinking alcohol while taking Antabuse can cause dangerous symptoms." D) "If I drink while taking Antabuse, it will make me vomit before the alcohol affects me."
C
A nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse 4 years ago and attends AA meetings occasionally. Which of the following statements made by the recovering husband should alert the nurse for the need for further education? A) "I still need to go to AA meetings even though I have been sober for years." B) "After all these years I just don't have the will power to stop if I started using again." C) "She gets upset when I hang out with my old buddies on the weekends." D) "I wish I could be able to handle just one beer with dinner."
C
A patient is being discharged on disulfiram (Antabuse). The patient should receive which of the following instructions related to the use of Antabuse? A) Take disulfiram with food to avoid stomach upset B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely C) Read products labels carefully to avoid all products containing alcohol D) Disulfiram will prevent the desire to drink alcoholic beverages
C
The nurse is assessing the drinking history of a patient being admitted for alcohol abuse. Which of the following statements reflects the most probable patient statement at this time? A) "I really need some help. My drinking is tearing my family apart." B) "I have tried so many times to stop drinking. It is so hard." C) "I don't really have a problem with alcohol. I've just been having a streak of bad luck lately." D) "I have no intention to stop drinking. I like the way it makes me feel."
C
A client has been admitted to the inpatient unit after using inhalants recently. Which of the following is an antidote to treat inhalant toxicity? A) Ativan B) Narcan C) Antabuse D) There is no antidote
D
A patient in treatment for drug abuse makes the statement, "I am a winner. You all are the losers because you can't beat this on your own." The nurse interprets this statement as reflecting which characteristic common to people addicted to drugs? A) Realistic understanding of successful recovery of drug addiciton B) Indication of an underlying personality disorder C) Brain damages resulting from chronic drug use D) Defending against a negative self-concept
D
An unconscious patient is admitted to the emergency department after a motor vehicle accident. The patient's blood alcohol level upon admission was 1.7. The patient's family soon arrives, reporting that this is an uncle that is visiting from out of town. They cannot give much more history other than that he is a "social drinker". After being transported to the unit, the patient starts sweating and has elevated vital signs. It is most important for the nurse to continue gathering history from the family regarding which of the following? A) Who is the next of kin? B) For what occasion is the uncle visiting from out of town? C) Does the uncle have a history of any sort of anxiety disorder? D) Are there other indications that the patient may be a heavy drinker?
D
Neurochemical influences on substance abuse patterns point to which of the following explanations as the probable cause of substance abuse? A) Imbalances of serotonin and norepinephrine in the brain B) Inhibition of GABA in the brain C) Excessive serotonin activity in the CNS D) Stimulation of dopamine pathways in the brain
D
The wife of an alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which of the following is the nurse's best response? A) "Help him avoid embarrassment by supporting him when he makes excuses for failing to meet obligations." B) "Include him in family outings even when he is drinking." C) "Search the house regularly for alcohol." D) "Try to maintain a normal home environment for yourself and the children."
D
The nurse is assessing a patient's risk factors for developing a substance abuse disorder. Which of the following family characteristics would the nurse identify as a significant risk factor? A) One parent that is an alcoholic B) Parents who practiced strict discipline C) Overprotective parents D) Being raised in an urban area
A
A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. The nurse recognizes these symptoms as typical of which of the following? A) Alcohol withdrawal syndrome B) Continuing intoxication C) Delirium tremens D) Wernicke-Korsakoff syndrome
A
A patient calls the emergency department of the local hospital reporting that after 16 years of heavy drinking he is tired and wants to quit "cold turkey". The best response by the nurse would be: A) "Is there a family member that can bring you in right away? It is not safe to stop drinking suddenly without medicine." B) "You sound really motivated. Come in and we will help you find a treatment center." C) "After a few days of rest you should feel much better as long as you do not drink anything." D) "You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3-5 days."
A
A patient is readmitted to the detox unit for the 4th time in 3 years. The nurse states in the morning report, "Not again! Why should we keep trying to help this guy? He obviously doesn't want it." This statement reflects which of the following? A) The nurse lacks the self awareness to work effectively with this addicted patient B) The nurse understands the cycle of remission and relapse characteristic of addiction C) The nurse has repressed negative emotions from past experiences with addiction D) The nurse needs education of the chronic nature of addiction
A
The nurse is co-leading a family therapy group with a patient addicted to alcohol. Which statement made by the wife indicates the need for additional education regarding alcoholism as a family illness? A) "I have to call in sick for my husband when he is too hung over to go to work." B) "Last time he got arrested I just let him sit in jail." C) "We have separated our finances so that I will not go broke." D) "I take my kids with me to Al-anon meetings every week."
A
The nurse is discussing the principles of 12-step programs for recovery with a patient. Which of the following is consistent with the principles of 12-step programs? A) The patient will need to abstain from all substances for successful recovery B) Once sober, the person can safely return to life as it was before becoming addicted C) The prognosis for recovery is enhanced with the aid of maintenance medications D) Recovery requires adherence to a plan of achieving long-term goals
A
A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, "I am so ashamed." Which of the following would be the best response by the nurse? A) "I really thought you would make it." B) "Tell me what has happened since your last admission." C) "You have nothing to be ashamed of." D) "Why did you start drinking again?"
B
A client with alcohol dependence is admitted to the hospital with pancreatitis. Which of the following interventions should be included in the client's plan of care? A) Fluid restriction of 1,000 mL per 24 hours B) Glucometer checks bid C) High-protein diet D) Protective isolation precautions
B
A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program? A) Teenagers in a high school health class B) School age children in an after school program C) Parents attending a parent-teacher association meeting D) Elementary school teachers and counselors
B
A nurse is exploring treatment options with a patient addicted to heroin. The nurse would include which of the following information regarding the use of methadone? A) Unlike heroin, methadone is non-addicting B) Methadone will prevent the craving for heroin C) Methadone will produce a high similar to heroin D) People taking methadone run the same risks associated with IV drug use as those taking heroin
B
A nurse reports for work looking unkempt and disheveled. Her movements are uncoordinated and her breath smells like mouthwash. Another nurse suspects this nurse is intoxicated. What should the nurse do first? A) Call the supervisor to report the nurse's behavior. B) Confront the nurse about her behavior and relieve her of her responsibilities. C) Give the nurse some information about the hospital's employee assistance program. D) Ignore the situation until someone else validates the observations.
B
A nurse suspects a co-worker is signing out narcotics for patients and is using them herself. Which action should be taken by the nurse who has these suspicions? A) Ignore suspicions and leave it to the supervisor to intervene B) Report the observations to the supervisor C) Follow behind the co-worker to ensure patient comfort and safety D) Confront the co-worker about suspicions
B
A patient is being discharged from treatment for addiction to cocaine. Which of the following statements made by the patient would cause the most concern for the nurse? A) "I am going to take up a new hobby. It's time to start something new." B) "I can still hang out with my old friends. I am just not going to use." C) "I'm not very comfortable with being alone yet." D) "Shooting baskets helps me not think about getting high."
B
The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. Which of the following is an example of codependent behavior? A) The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B) The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. C) The friend confronted the client on the effect of his drinking on their relationship. D) The friend refused to go out drinking with the client to celebrate the client's birthday.
B
The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which of the following is the best action for the nurse to take? A) Ask other nurses if they have noticed anything unusual. B) Call the manager and report the observations. C) Observe the nurse as injections are prepared and administered. D) Tell the nurse, "I know you've been stealing Valium."
B
A patient reports drinking 1-2 drinks when drinking behavior first began. Now the patient reports drinking at least 6 drinks with every episode in order to "Have a good time". The patient is describing the phenomenon known as: A) dependence. B) intoxication. C) tolerance. D) withdrawal.
C
A client is admitted for a drug overdose with a central nervous system (CNS) depressant. The priority nursing action when planning care for this client would be to A) Check the client's belongings for additional drugs B) Pad the side rails of the bed because seizures are likely C) Prepare a dose of ipecac, an emetic D) Monitor respiratory function
D
The patient asks the nurse, "What will happen if I drink while taking Antabuse?" The most accurate response by the nurse would be which of the following? A) "You will not want to drink while taking Antabuse. It reduces the cravings." B) "You will not get any effect from the alcohol you drink." C) "Antabuse will reverse the effects of alcohol." D) "You will experience a severe reaction including a throbbing headache and vomiting."
D