Chapter 22 Substance-Related and Addictive Disorders-ALL

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 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 patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? (Select all that apply) A. Intense nausea B. Diaphoresis C. Acute paranoia D. Confusion E. Dyspnea

A. Intense nausea B. Diaphoresis D. Confusion E. Dyspnea

Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? (Select all that apply) A. Pupils are dilated B. Pulse rate is 62 beats/min C. Slow movements D. Extreme anxiety E. Sleepy

A. Pupils are dilated D. Extreme anxiety

4. The treatment team meets to discuss Cody's plan of care. Which of the following factors will be priorities when planning interventions? A. Readiness to change and support system B. Current college performance C. Financial ability D. Availability of immediate family to come to meetings

A. Readiness to change and support system

7. A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn? A. The client has a high tolerance to alcohol. B. The client ate a high-fat meal before drinking. C. The client has a decreased tolerance to alcohol. D. The client's blood alcohol level is within legal limits.

A. The client has a high tolerance to alcohol.

6. A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating: A. denial. B. projection. C. rationalization. D. reaction formation.

A. denial.

2. The only class of commonly abused drugs that has a specific antidote is the: A. opiates. B. hallucinogens. C. amphetamines. D. benzodiazepines.

A. opiates.

23. 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.

ANS: A An overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

11. A patient admitted to an alcohol 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. Projection c. Introjection d. Rationalization

ANS: A Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjection involves incorporating a quality of another person or group into one's own personality.

30. 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.

ANS: A The correct response recognizes the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

MULTIPLE RESPONSE 2. 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.

ANS: A, C, E Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse. Patients need the support of friends and family to establish and maintain sobriety.

27. 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. hallucinogen ingestion. c. opium intoxication. d. cocaine overdose.

ANS: B The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going "crazy." Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. Phencyclidine (PCP) use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

24. 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.

ANS: B The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis.

25. 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 abuse. c. substance addiction. d. substance intoxication.

ANS: C Nicotine meets the criteria for a "substance," the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose. The scenario does not meet criteria for substance abuse, intoxication, or cross-tolerance.

4. 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/minute. 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.

ANS: C Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

26. 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

ANS: D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use.

12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine b. Methadone c. Disulfiram d. Naltrexone

ANS: D Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

20. 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."

ANS: D Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

22. A patient diagnosed 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. Long-term outpatient therapy c. 12-step self-help program d. Residential program

ANS: D Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, become self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

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.)

1. Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? A. Opiates B. Marijuana C. Barbiturates D. Hallucinogens

C. Barbiturates

9. In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery? A. Ongoing support from at least two family members must be secured. B. The client needs to be employed. C. The client must strive to maintain abstinence. D. A regular schedule of appointments with a primary care provider must be set up.

C. The client must strive to maintain abstinence.

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.)

What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder? A. Accompany the staff member when she is giving patient care. B. Offer to attend rehabilitation counseling with her. C. Refer her to a peer assistance program. D. Confront her about your concerns and/or report your concerns to a supervisor immediately.

D. Confront her about your concerns and/or report your concerns to a supervisor immediately.

Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is: A. Bored B. Depressed C. Bipolar D. Not ready to change

D. Not ready to change

7. What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? A. The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. B. Neither should be reported until the nurse has collected factual evidence. C. No report should be made until suspicions are confirmed by a second staff member. D. Supervisory staff should be informed as soon as possible in both cases.

D. Supervisory staff should be informed as soon as possible in both cases.

4. Benzodiazepines are useful for treating alcohol withdrawal because they: A. block cortisol secretion. B. increase dopamine release. C. decrease serotonin availability. D. exert a calming effect.

D. exert a calming effect.

9. A patient asks for information about AA. Select the nurse's best response. "AA 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."

ANS: B AA is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

3. A nurse cares for a patient experiencing an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurological d. Hepatic

ANS: B Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority.

31. 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.

ANS: C The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one's own perspective. Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.

5. A patient admitted yesterday for injuries sustained while intoxicated believes insects 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

ANS: D The patient's clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

29. 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. Heroin c. Barbiturates d. Amphetamines

ANS: D The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

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.)

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 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.)

Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings account is down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states: A. "I understand that I am a bad person for depleting our savings." B. "Gambling activates the reward pathways in my brain." D. "Gambling is the only thing that makes me feel alive." D. "We have always enjoyed gaming. I do not know why Eileen is so upset."

B. "Gambling activates the reward pathways in my brain."

8. A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested: A. LAAM B. GHB C. ReVia D. Clonidine

B. GHB

5. A person who covertly supports the substance-abusing behavior of another is called a(n): A. patsy. B. enabler. C. participant. D. minimizer.

B. enabler

9. A teaching need is revealed when a client taking disulfiram (Antabuse) states: A. "I usually treat heartburn with antacids." B. "I take ibuprofen or acetaminophen for headache." C. "Most over-the-counter cough syrups are safe for me to use." D. "I have had to give up using aftershave lotion."

C. "Most over-the-counter cough syrups are safe for me to use."

Opioid use disorder is characterized by: A. Lack of withdrawal symptoms. B. Intoxication symptoms of pupillary dilation, agitation, and insomnia. C. Tolerance. D. Requiring smaller amounts of the drug to achieve a high over time.

C. Tolerance.

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.)

2. Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of: A. tremors. B. seizures. C. blackouts. D. hallucinations.

A. tremors.

21. Which goal for treatment of alcohol use disorder should the nurse address first? a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiological stability.

ANS: D The individual must have completed withdrawal and achieved physiological stability before he or she is able to address any of the other treatment goals.

5. Cocaine exerts which of the following effects on a client? A. Stimulation after 15 to 20 minutes B. Stimulation and anesthetic effects C. Immediate imbalance of emotions D. Paranoia

B. Stimulation and anesthetic effects

1. Erik is a 26-year-old patient who abuses heroin. He states to you, "I've been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want." You know this describes: A. intoxication. B. tolerance. C. withdrawal. D. addiction

B. tolerance.

Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is: A. Risk for injury/Remains free from injury. B. Ineffective denial/Accepts responsibility for behavior. C. Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs. D. Risk for suicide/Expresses feelings, plans for the future.

C. Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs.

6. An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will: A. discuss the addiction with significant others. B. state an intention to stop using illegal substances. C. abstain from the use of mood-altering substances. D. substitute a less addicting drug for the present drug.

C. abstain from the use of mood-altering substances.

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.)

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 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.)

4. Which assessment data would be most consistent with a severe opiate overdose? A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min B. Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min C. Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min D. Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

A. Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min

10. Symptoms that would signal opioid withdrawal include: A. lacrimation, rhinorrhea, dilated pupils, and muscle aches. B. illusions, disorientation, tachycardia, and tremors. C. fatigue, lethargy, sleepiness, and convulsions. D. synesthesia, depersonalization, and hallucinations.

A. lacrimation, rhinorrhea, dilated pupils, and muscle aches.

16. Which features should be present in a therapeutic milieu for a patient experiencing a hallucinogen overdose? a. Simple and safe b. Active and bright c. Stimulating and colorful d. Confrontational and challenging

ANS: A Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

18. 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. assertiveness. c. role reversal. d. homeostasis.

ANS: A Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario.

13. 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."

ANS: A During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontational

ANS: A Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

28. 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 (IOM)-National Research Council c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine

ANS: A The SAMHSA is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

17. 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.

ANS: A Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

MULTIPLE RESPONSE 3. After discovering discrepancies and missing controlled substances, the nursing supervisor determines that a valued, experienced staff nurse is responsible. Which actions should the nursing supervisor take? (Select all that apply.) a. Refer the nurse to a peer assistance program. b. Confront the nurse in the presence of a witness. c. Immediately terminate the nurse's employment. d. Relieve the nurse of responsibilities for patient care. e. Require the nurse to undergo immediate drug testing.

ANS: A, D Registered nurses may have personal substance use problems. The nursing supervisor should provide for safe patient care by relieving the nurse of responsibility for patient care. For those nurses experiencing addictions, there are nonpunitive alternatives to discipline programs in the form of peer assistance. Many state boards of nursing have developed an alternative to discipline program to help impaired nurses. Terminating the nurse's employment and confronting the nurse in the presence of a witness are punitive actions. The peer assistance program will manage drug testing.

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates poor coordination and slurred speech but the vital signs are normal. The blood alcohol level is 300 mg/dL (0.30 g/dL). Considering the relationship between the assessment findings 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.

ANS: B A nontolerant drinker would have sleepiness and significant changes in vital signs with a blood alcohol level of 300 mg/dL (0.30 g/dL). The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

1. A patient diagnosed with alcohol use disorder 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."

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

2. 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/minute 0400: 126/80 mm Hg and 76 beats/minute 0600: 128/82 mm Hg and 72 beats/minute 0800: 132/88 mm Hg and 80 beats/minute 1000: 148/94 mm Hg and 96 beats/minute What is the nurse's priority action? a. Force fluids. b. Begin the detox protocol. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

ANS: B Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for detox with medical intervention to prevent a hypertensive crisis and/or seizures. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

7. A hospitalized patient diagnosed with alcohol use 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

ANS: B One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels

6. A hospitalized patient diagnosed with alcohol use 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. b. sedative, such as lorazepam or chlordiazepoxide. c. antipsychotic, such as olanzapine or thioridazine. d. monoamine oxidase inhibitor antidepressant, such as phenelzine.

ANS: B Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

19. In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/minute; respirations 8 breaths/minute and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to opioid 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/minute, and respirations at or above 12 breaths/minute. 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.

ANS: B The correct short-term outcome is the only one that relates to the patient's physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patient's respirations are slow and shallow, but there is no evidence of congestion.

MULTIPLE RESPONSE 1. A patient undergoing alcohol rehabilitation decides to begin disulfiram 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.

ANS: B, C, F The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.

14. 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.

ANS: C Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

MULTIPLE RESPONSE 4. A new patient beginning an alcohol 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." Which responses by the nurse will be most therapeutic? (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."

ANS: C, D The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

8. A patient diagnosed with alcohol use 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."

ANS: D The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

3. Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital? A. Cody will return to a predrug level of functioning within 1 week. B. Cody will be medically stabilized while in the hospital. C. Cody will state within 3 days that he will totally abstain from drugs and alcohol. D. Cody will take a leave of absence from college to alleviate stress.

B. Cody will be medically stabilized while in the hospital.

Max is a 30-year-old male who arrives at the emergency department stating "I feel like I am having a stroke". During the intake assessment, the nurse discovers that Max has been working for 36 hours straight without eating and has consumed eight double espresso drinks and 12 caffeinated sodas. The nurse suspects: A. Fluid overload B. Dehydration and caffeine overdose C. Benzodiazepine overdose D. Sleep deprivation syndrome

B. Dehydration and caffeine overdose

The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? (Select all that apply) A. Reports inability to cope. B. Does not perceive danger of substance use or gambling. C. Minimizes symptoms. D. Refuses healthcare attention. E. Unable to admit impact of disease on life pattern.

B. Does not perceive danger of substance use or gambling. C. Minimizes symptoms. D. Refuses healthcare attention. E. Unable to admit impact of disease on life pattern.

A patient diagnosed with opioid use disorder had expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success? A. Restrict visitors to family members only. B. Manage the patient's withdrawal symptoms well. C. Provide the patient a low stimulus environment. D. Advocate for at least 3 months of treatment.

B. Manage the patient's withdrawal symptoms well.

8. A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is: A. taking him to the gym on the psychiatric unit. B. obtaining an order for seclusion and close observation. C. assigning a psychiatric technician to "talk him down." D. administering naltrexone as needed per hospital protocol.

B. obtaining an order for seclusion and close observation.

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.)

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.)

2. Which of the following is true regarding substance addiction and medical comorbidity? A. Most substance abusers do not have medical comorbidities. B. There has been little research done regarding substance addiction disorders and medical comorbidity. C. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. D. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.

C. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.

10. The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses A. are an indicator of treatment failure. B. are caused by physiological changes. C. result from lack of good situational support. D. can be learning situations to prolong sobriety.

C. result from lack of good situational support.

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 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.)

5. Cody is preparing for discharge. He tells you, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? A. "It helps your mood so that you don't feel the need to do drugs." B. "It will keep you from experiencing flashbacks." C. "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions." D. "It helps prevent relapse by reducing drug cravings."

D. "It helps prevent relapse by reducing drug cravings."

3. A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include: A. induction of vomiting. B. administration of ammonium chloride. C. monitoring of opiate withdrawal symptoms. D. observation for hyperpyrexia and seizures.

D. observation for hyperpyrexia and seizures.

3. The term tolerance, as it relates to substance abuse, refers to: A. the use of a substance beyond acceptable societal norms. B. the additive effects achieved by taking two drugs with similar actions. C. the signs and symptoms that occur when an addictive substance is withheld. D. the need to take larger amounts of a substance to achieve the same effects.

D. the need to take larger amounts of a substance to achieve the same effects.

1. A syndrome that occurs after stopping the long-term use of a drug is called: A. amnesia. B. tolerance. C. enabling. D. withdrawal.

D. withdrawal.