Mental Health: Addiction
50. A client diagnosed with chronic alcohol use disorder complains of feeling tremulous. The client's BP is now 170/110, P 116, R 30, T 97°F. The nurse anticipates which medication would give the client the most immediate relief from these symptoms? 1) Benztropine (Cogentin), 2 mg PO 2) Oxazepam (Serax), 30 mg PO 3) Lorazepam (Ativan), 1 mg IM 4) Meperidine (Demerol), 100 mg IM
3) Lorazepam (Ativan), 1 mg IM Ativan is frequently used to treat the symptoms of alcohol withdrawal. Because Ativan is ordered parenterally, this medication would give the client the most immediate relief of symptoms.
39. Which nursing intervention relates to rehabilitative care for a recovering alcoholic? 1) Providing a safe and supportive environment during alcohol withdrawal 2) Teaching about physical symptoms 3) Providing client and family education and assistance during treatment 4) Encouraging continued participation in AA
4) Encouraging continued participation in AA Because recovery is a long-term process, it is critical that the nurse encourage continuous participation in outpatient support systems such as AA.
42. Which is the most serious symptom experienced during alcohol withdrawal? 1) Blackout 2) Acute withdrawal delirium 3) Hypotension 4) Seizure
4) Seizure During alcohol withdrawal, the central nervous system (CNS) rebounds from the effects of suppression caused by alcohol intake. This excitation of the CNS can lead to grand mal seizures and other complications, which are life-threatening. This is the most serious complication of alcohol withdrawal syndrome.
The recommended first-line pharmacologic agents for managing severe alcohol withdrawal symptoms are a) serotonin reuptake inhibitors. b) major tranquilizers. c) benzodiazepines. d) atypical antipsychotics.
c) benzodiazepines.
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink? a) 24 b) 2 c) 16 d) 8
d) 8
The mental health nurse recognizes that genetic intolerance of alcohol has been documented among ethnic a) Italians b) Africans c) Germans d) Asians
d) Asians
Which of the following is the most common defense mechanism used by a client diagnosed with a substance use problem? a) Repression b) Regression c) Suppression d) Denial
d) Denial
Which drug reverses opioid toxicity? a) Disulfiram (Antabuse) b) Methadone c) Clonidine (Catapres) d) Naloxone (Narcan)
d) Naloxone (Narcan)
A client tells the nurse that she went to a party and had several drinks. When she woke up the next morning, she could not remember driving home. What does the nurse suspect? a) The client was using other drugs in addition to the alcohol. b) The client has alcoholic amnestic disorder. c) The client has an underlying neurologic problem. d) The client had a blackout.
d) The client had a blackout.
52. A client is being discharged from an alcohol treatment program. The client's wife states, "I'm so afraid that when my husband leaves here, he'll relapse. How can I deal with this?" Which nursing statement would be most appropriate? 1) "Many family members of alcoholics find the Al-Anon support group to be helpful." 2) "You could try going out and having a few beers with him when he gets the urge to drink." 3) "Just make sure he doesn't drink at home. Find all of his hidden bottles and empty them." 4) "Tell your husband that if he drinks again, you will leave him."
1) "Many family members of alcoholics find the Al-Anon support group to be helpful." Al-Anon is a nonprofit organization that provides group support for the family and close friends of alcoholics.
46. Pamela has sought treatment for ongoing substance use disorder. She asks the nurse what treatment options are available to help her combat this problem. Which of these options would be accurate for the nurse to include inpatient education? Select all that apply. 1) ECT 2) Self-help groups 3) Deterrent therapy 4) Substitution pharmacotherapy 5) Vitamin supplements
2) Self-help groups 3) Deterrent therapy 4) Substitution pharmacotherapy Feedback 1: ECT is primarily indicated for the treatment of depression. There is no evidence of its benefit in preventing relapse in substance use disorders. Correct 2: Self-help groups such as Alcoholics Anonymous are commonly recommended as a treatment option for substance use disorders. Correct 3: Deterrent therapy, such as Antabuse to deter alcohol use, is a recognized option for some substance use disorders. Correct 4: Substitution therapy, such as methadone for heroin users, is a recognized option for some substance use disorders. Feedback 5: Vitamin supplements are beneficial in reversing nutritional deficiencies in alcoholism and other substance use disorders but do not combat the problem of substance use disorder itself.
36. A client who is going through alcohol detoxification states, "I see bugs crawling on the wall." Which is the best nursing response? 1) "I'll remove the bugs from the wall." 2) "You are confused because of your alcoholism." 3) "There are no bugs on the wall. I'll stay with you until you feel less anxious." 4) "You do not see any bugs on the wall."
3) "There are no bugs on the wall. I'll stay with you until you feel less anxious." This response presents objective reality and may help decrease the client's anxiety by the nurse's therapeutic offering of self.
51. A client with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? 1) Carbamazepine (Tegretol) 2) Clonidine (Catapres) 3) Disulfiram (Antabuse) 4) Folic acid (Folvite)
3) Disulfiram (Antabuse) Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high enough. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol are strictly prohibited when taking this drug.
38. When teaching a client diagnosed with alcoholism about nutritional needs, which nutritional concept should the nurse emphasize? 1) Eat a high-protein, low-carbohydrate diet to promote lean body mass. 2) Increase sodium-rich foods to increase iodine levels. 3) Provide multivitamin supplements, including thiamine and folic acid. 4) Restrict fluid intake to decrease the renal load.
3) Provide multivitamin supplements, including thiamine and folic acid. Vitamin B deficiencies contribute to the nervous system disorders seen in chronic alcohol abuse. Supplements of these vitamins are important to prevent complications. It is important that vitamin supplements include both thiamine (vitamin B1) and folic acid.
49. A client is diagnosed with stimulant use disorder: cocaine and antisocial personality disorder. The client eagerly participates in therapy and becomes charming and ingratiating to the primary nurse. Which best describes these client behaviors? 1) The client has not completed the cocaine withdrawal process. 2) The client is probably hiding something. 3) The client is exhibiting characteristics of antisocial personality disorder. 4) The client is exhibiting symptoms of cocaine dependence.
3) The client is exhibiting characteristics of antisocial personality disorder.
32. An impaired nurse is admitted to an inpatient substance abuse treatment facility. Which applies to his situation? 1) The nurse must relinquish his driver's license to the office of motor vehicles. 2) The nurse is mandated to comply with treatment and prescribed therapies. 3) The nurse is not mandated to meet specific requirements, because all civil rights are ensured. 4) The nurse must relinquish his registered nurse (RN) license to the state board of nursing.
3) The nurse is not mandated to meet specific requirements, because all civil rights are ensured. Although some variations occur from state to state, currently psychiatric clients maintain all of their civil rights. This nurse is not mandated by law to meet specific requirements, because all civil rights are ensured.
34. Which symptom would the nurse expect to observe in a client experiencing opioid intoxication? 1) Insomnia 2) Abdominal cramps 3) Muscle aches 4) Impaired judgment
4) Impaired judgment Impaired judgment; initial euphoria followed by apathy; dysphoria; and psychomotor agitation or retardation are all symptoms of opioid intoxication.
47. On admission, a client experienced severe alcohol withdrawal symptoms. Four days later, the nurse notes a decrease in withdrawal symptoms. Which nursing intervention is most appropriate? 1) Withhold potentially addictive as needed (PRN) medications. 2) Increase PRN medications because potentially fatal complications can still occur. 3) Ask the doctor to prescribe a less addictive medication to reduce the potential for dependence. 4) Monitor for withdrawal complications and administer medications on the basis of client symptoms.
4) Monitor for withdrawal complications and administer medications on the basis of client symptoms. The nurse must remain vigilant because withdrawal complications can occur days after initial withdrawal symptoms appear. Medication dosages for withdrawal should be based on an objective assessment of symptoms. This is usually done by the use of an assessment tool such as Clinical Institute Withdrawal Assessment (CIWA).
53. A client is brought to the ED. The client is aggressive, has slurred speech, and exhibits impaired motor coordination. The blood alcohol level is 347 mg/dL. Among the physician's orders is thiamine. Which is the rationale for this intervention? 1) To prevent nutritional deficits 2) To prevent pancreatitis 3) To prevent alcoholic hepatitis 4) To prevent Wernicke's encephalopathy
4) To prevent Wernicke's encephalopathy Wernicke's encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.
The nurse believes that a client is admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation
ANS: C The CAGE questionnaire is a screening tool used to determine the diagnosis of alcoholism. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.
A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? A. "Why do you assume responsibility for his behaviors?" B. "Codependency is a typical behavior of spouses of alcoholics." C. "Your husband needs to deal with the consequences of his drinking." D. "Do you understand what the term 'enabler' means?"
ANS: C The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Partners of clients with substance abuse must come to realize that the only behavior they can control is their own.
A client diagnosed with alcohol abuse joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.
ANS: C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.
Upon admission for symptoms of alcohol withdrawal a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping
ANS: C The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.
During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.
ANS: C The nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.
On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.
ANS: C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.
A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports getting to sleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium
ANS: C Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.
A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."
ANS: A Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.
Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy
ANS: D A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.
Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."
ANS: D A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.
A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.
ANS: A The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.
A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by a family who reports that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.
ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.
A client diagnosed with depression and substance abuse has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. B. Sedative-hypnotics are expensive and have numerous side effects. C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.
ANS: A The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another and are capable of producing physiological and psychological dependence.
A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.
ANS: A The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.
What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences
ANS: A The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.
A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension
ANS: A Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.
Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with substance-abuse disorders? (Select all that apply.) A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." C. "I need to review the side effects of the medications used in the withdrawal process." D. "I'll need to set boundaries to maintain a therapeutic relationship." E. "I need to take charge when dealing with clients diagnosed with substance disorders."
ANS: A, B, D A: "I am easily manipulated and need to work on this prior to caring for these clients." B: "Because of my father's alcoholism, I need to examine my attitude toward these clients." D: "I'll need to set boundaries to maintain a therapeutic relationship." The nurse should examine personal bias and preconceived negative attitudes prior to caring for clients diagnosed with substance-abuse disorders. A deficit in this area may affect the nurse's ability to establish therapeutic relationships with these clients.
A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence? A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.
ANS: B The nurse should assess the client for substance dependence because clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics, and require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client's response to another drug.
A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL
ANS: B The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.
A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediately report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on a numeric scale D. Dehydration
ANS: B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.
A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors
ANS: D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.
Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)
ANS: D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.
Which client statement indicates a knowledge deficit related to substance abuse? A. "Although it's legal, alcohol is one of the most widely abused drugs in our society." B. "Tolerance to heroin develops quickly." C. "Flashbacks from LSD use may reoccur spontaneously." D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."
ANS: D The nurse should determine that the client has a knowledge deficit related to substance abuse when the client compares marijuana to smoking cigarettes and claims it to be harmless. Cannabis is the second most widely abused drug in the United States.
A nurse is interviewing a client in an outpatient substance-abuse clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? A. The client will identify one person to turn to for support. B. The client will give up all old drinking buddies. C. The client will be able to verbalize the effects of alcohol on the body. D. The client will correlate life problems with alcohol use.
ANS: D To promote the recovery process the nurse should expect that the client would initially correlate life problems with alcohol use. Acceptance of the problem is the first step of the recovery process.
People addicted to alcohol and drugs have a rate of suicide that is what percentage higher than that of the general population? a) 20 b) 30 c) 40 d) 10
a) 20
A nurse is conducting a seminar with a local parent group about substance use and abuse. The nurse determines that the seminar was successful when the group identifies which of the following as the substance most abused in the United States? a) Alcohol b) Heroin c) Marijuana d) Cocaine
a) Alcohol
A client who has used IV heroin every day for the past 10 years says, "I don't have a drug problem. I can quit whenever I want." Which of the following defense mechanisms is being used by the client? a) Denial b) Compensation c) Repression d) Rationalization
a) Denial
Tracy consumed alcohol almost daily while she was pregnant. Her newborn baby has growth deficiency and facial malformations. What is the name for the pattern of birth defects that can occur due to exposure to alcohol? a) Fetal alcohol syndrome b) Natal alcohol syndrome c) Fatal alcohol syndrome d) Prenatal alcohol syndrome
a) Fetal alcohol syndrome
The nurse is assessing a client she suspects may have a drinking problem. She asks the client how much alcohol he drinks per day. The client replies, "The important point is that even if I have 10 drinks, I don't get drunk. I can hold my liquor." The client's reply suggests which of the following? a) He has become tolerant to alcohol. b) He is minimizing his intake. c) He has blackouts. d) He may drink frequently or a lot, but he doesn't have a problem.
a) He has become tolerant to alcohol.
After educating a group of students about caffeine, the instructor determines that the education was successful when the group identifies which of the following as indicating intoxication? Select all that apply. a) Insomnia b) Pale face c) Nervousness d) Urinary retention e) Restlessness f) Excitement
a) Insomnia c) Nervousness d) Urinary retention e) Restlessness f) Excitement
When discussing methadone treatment with a client, the nurse teaches what? a) It decreases the severity of heroin withdrawal symptoms. b) The cure rate is extremely high. c) It is a nonaddictive treatment. d) It takes 1 to 2 years to cure an opiate addict.
a) It decreases the severity of heroin withdrawal symptoms.
After a long history of intravenous heroin use, a client has expressed willingness to stop using heroin. The nurse would expect the client to receive which medication to decrease the severity of withdrawal? a) Methadone b) Gabapentin (Neurontin) c) Ondansetron (Zofran) d) Amphetamines
a) Methadone
When educating the public concerning marijuana use, the nurse stresses that heavy, regular use is likely to result in a) Psychological dependence with an increased risk for self-harm b) Accidental drug poisoning and tachycardia c) Both physiological and psychological dependence and an increased risk for respiratory problems d) Extraordinary pain tolerance and extreme hypertension
a) Psychological dependence with an increased risk for self-harm
Which of the following terms describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking? a) Tolerance break b) Intoxication c) Tolerance d) Blackout
a) Tolerance break
When educating the public regarding substance-related disorders, the mental health nurse explains that the condition of drug dependence is a state defined as ... a) Physical effects resulting from the multiple episodes of substance use b) Chronic or recurrent drug intoxication, characterized by psychological and physical dependence c) Emotional dependence on a drug or a desire or compulsion to continue taking a drug d) Substance-seeking activities and pathological use patterns of the person using substances
b) Chronic or recurrent drug intoxication, characterized by psychological and physical dependence
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience? a) Norepinephrine b) Dopamine c) Serotonin d) Acetylcholine
b) Dopamine
When a client is working toward the prevention of an alcohol abuse relapse, the nurse is most therapeutic when a) Discussing the pros and the cons of alcohol abuse b) Helping the client identify positive coping mechanisms c) Planning strategies to prevent further relapses d) Monitoring the effects of treatment
b) Helping the client identify positive coping mechanisms
When conducting an adolescent drug awareness program, the nurse describes which of the following drugs as having the highest addiction potential? a) Marijuana and nicotine b) Heroin and morphine c) Cocaine and codeine d) Amphetamines and barbiturates
b) Heroin and morphine
All of the following are positive aspects regarding methadone for heroin addiction except ... a) It is controlled be a physician. b) It is available in IV form. c) It is available in tablet form. d) It is a legal medication.
b) It is available in IV form.
While working as a nurse in a hospital, you notice that a co-worker has unsteady gait and slurred speech. You suspect that your co-worker may be an impaired nurse. Which of the following would be the appropriate action to take? a) Ignore your co-worker's behavior until others notice the problem. b) Report your co-worker's behavior to your supervisor. c) Confront the co-worker with your suspicions. d) Ask your co-worker to perform a sobriety test.
b) Report your co-worker's behavior to your supervisor.
A client drinks 24 oz of vodka every day, having gradually increased to this level over the past 2 to 3 years. The client continues to maintain a job and functions well in activities of daily living, relationships, and other aspects of social life. Which of the following terms should the nurse use to describe this drinking behavior? a) Intoxication b) Tolerance c) Withdrawal d) Abuse
b) Tolerance
The nurse is conducting a health promotion class on drug awareness with a group of junior high school students. Which of the following teaching points should the nurse include in this session? a) "Heavy marijuana use has resulted in severe withdrawal symptoms in some people once they decide to quit." b) "Marijuana and heroin actually have a very similar potential for addiction." c) "Marijuana use can result in psychological dependence, which can have a very negative effect on your life." d) "Most people are unaware of the fact that marijuana is actually a very addictive drug."
c) "Marijuana use can result in psychological dependence, which can have a very negative effect on your life."
Supported by research results, the mental health nurse includes alcohol-related problem assessment questions when interviewing ... a) All adult females b) All males between the ages of 18 and 45 years of age c) All clients regardless of age and gender d) White males 45 to 65 years of age
c) All clients regardless of age and gender
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to his history of alcohol abuse? a) Pancreatitis, esophagitis, gastritis, and elevated liver enzymes b) Pancreatitis and elevated liver enzymes c) All the conditions are attributable to the alcohol abuse d) Gastritis and elevated liver enzymes
c) All the conditions are attributable to the alcohol abuse
A client has been using paint thinner and glue to receive a "high." The nurse knows that these substances are ... a) Hypnotics b) Hallucinogens c) Inhalants d) Sedatives
c) Inhalants
When preparing to monitor a client scheduled for drug-managed substance detoxification, the nurse prepares the client for diagnostic testing to determine the functioning status primarily of the client's a) Lungs b) Stomach c) Liver d) Kidneys
c) Liver
A male in his 30s has been brought to the emergency department by emergency medical services with an apparent heroin overdose. In the immediate care of this client, what assessments should the nurse prioritize? a) Monitoring of fluid and electrolyte levels b) Musculoskeletal and integumentary assessments c) Neurological and respiratory assessments d) Psychosocial assessment and identification of support systems
c) Neurological and respiratory assessments
Which of the following statements most accurately describes the etiology of substance-related disorders? a) The primary predictors of substance-related disorders are childhood trauma and parental abuse or neglect. b) Substance abuse is a learned behavior. c) Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors. d) Substance-related disorders are primarily a result of the presence of an individual's inherently addictive personality.
c) Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors.
A young man has been brought to the emergency department (ED) by police after exhibiting bizarre and violent behavior on the patio outside a restaurant. Upon questioning, the man's girlfriend admits that he had been smoking PCP with his friend. While in the ED, the man continues to exhibit signs of PCP-induced psychosis and has required physical restraints. What nursing outcome should the nurse prioritize in the care of this patient? a) The client will demonstrate appropriate social skills. b) The client will verbalize acceptance of responsibility for his behavior. c) The client will be physically safe and without injury. d) The client will establish a balance of rest, sleep, and activity.
c) The client will be physically safe and without injury.
Which of the following medications is used to prevent Wernicke-Korsakoff syndrome? a) Folic acid (Folate) b) Cyanocabalamin c) Thiamine (vitamin B1) d) Lorazepam (Ativan)
c) Thiamine (vitamin B1)
A 51-year-old male has been admitted to the detoxification unit with acute symptoms of alcohol withdrawal. Nursing assessment is likely to reveal what? a) Anhidrosis, hypotonicity, and delusions b) Psychomotor hypoactivity, hypotension, and increased appetite c) Tremors, headache, flushed face, and hallucinations d) Hypomania, bradycardia, and generalized seizures
c) Tremors, headache, flushed face, and hallucinations
George is admitted to the detoxification unit on Sunday evening. His withdrawal symptoms from alcohol are most likely to begin, and he will likely need the most support, at what time? a) Friday evening b) Wednesday morning c) Tuesday evening d) Monday morning
c) Tuesday evening
Disulfiram (Antabuse) has been prescribed for a client receiving treatment for alcoholism. Which of the following should be included in the client's plan of care? a) Limit alcohol consumption to a moderate level b) Have weekly blood alcohol levels drawn c) Do not drive heavy machinery d) Avoid all products containing alcohol
d) Avoid all products containing alcohol
Safe alcohol withdrawal usually is accomplished with the administration of which medication classification? a) Anticonvulsants b) Antidepressants c) Antipsychotics d) Benzodiazepines
d) Benzodiazepines
Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by ... a) Spending a considerable amount of shift time off the unit b) Frequently calling off work for undefined illnesses c) Asking to be scheduled for weekend shifts as much as possible d) Having several clients complain that their pain medication is not working
d) Having several clients complain that their pain medication is not working
Which of the following is the best description of the term substance use disorders, according to the American Psychiatric Association? a) Indicates that the client does not experience tolerance and withdrawal symptoms b) Indicates that the client experiences tolerance and withdrawal symptoms c) Indicates that the client has a medical reason for taking the substance d) Is an umbrella term for substance abuse and substance dependence
d) Is an umbrella term for substance abuse and substance dependence
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what? a) Paxil b) Haldol c) Tegretol d) Librium
d) Librium
Which of the following medications is used to prevent alcohol withdrawal symptoms? a) Folic acid (Folate) b) Clonidine (Catapres) c) Naltrexone (ReVia) d) Lorazepam (Ativan)
d) Lorazepam (Ativan)
Sandra was diagnosed with cocaine abuse at age 30. When she was 23, Sandra was diagnosed with major depressive episode, and she has continued to have depression off and on since then. Which of the following is the most correct statement? a) Sandra is probably using cocaine in combination with her antidepressants to try to get higher. b) Sandra will have a very poor prognosis for recovery if she discontinues cocaine because it will enhance her depressive symptoms. c) Sandra will need to have the cocaine abuse treated before anything can be done about her depression. d) Sandra is probably using cocaine to cope with her depressive symptoms, and she would be considered to have a dual diagnosis.
d) Sandra is probably using cocaine to cope with her depressive symptoms, and she would be considered to have a dual diagnosis.
A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with her therapist, she states she is nervous about how her co-workers will respond to her now that "they all know I'm a drunk." Which of the following diagnoses best targets the problem implicit in the nurse's remarks? a) Powerlessness related to perceived inability to change the opinions of others b) Ineffective coping related to long history of alcohol use c) Anxiety related to situational crisis d) Situational low self-esteem related to medical condition
d) Situational low self-esteem related to medical condition
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind? a) Methadone is a not physiologically addictive. b) Methadone simulates the high of heroin. c) Methadone is a non-opioid drug. d) The drug helps to satisfy the craving for the opioid.
d) The drug helps to satisfy the craving for the opioid.
When assessing a client diagnosed with chronic alcoholism, the nurse addresses potential memory dysfunction by reviewing the client's serum level of ... a) Iron b) Vitamin E c) Vitamin C d) Thiamine
d) Thiamine
The major difference between substance abuse and substance dependency is that a) people who abuse substances are often seen by their peers as "alcoholic." b) in substance dependence, the individual has shared with his or her significant others that there is definitely a problem. c) people who are dependent often lose their jobs or drop out of school. d) a person who is abusing does not have withdrawal symptoms, whereas the dependent person uses the substance despite significant functional difficulties and will have withdrawal.
d) a person who is abusing does not have withdrawal symptoms, whereas the dependent person uses the substance despite significant functional difficulties and will have withdrawal.
Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include ... a) suicide precautions because suicide attempts are frequent during withdrawal. b) seizure precautions and vital signs. c) vital signs; medications as prescribed. d) observation for symptoms; vital signs; seizure and fall precautions; medications as ordered.
d) observation for symptoms; vital signs; seizure and fall precautions; medications as ordered.
John began drinking a six-pack of beer every day in his freshman year of college. By his sophomore year, he is drinking two six-packs to get the same effect. This phenomenon is best described as ... a) alcohol abuse b) dependence c) intoxication d) tolerance
d) tolerance
41. Paul, a 65-year-old Caucasian, is being seen at the health clinic for hypertension and has a history of alcohol use disorder. Which of the following observations by the nurse are consistent with physical complications associated with chronic alcohol use disorders? Select all that apply. 1) His skin is yellow. 2) He has a butterfly-shaped rash on his cheeks and nose. 3) His abdomen is distended. 4) He is coughing up blood. 5) He complains of acute pain in his left eye.
1) His skin is yellow. 3) His abdomen is distended. 4) He is coughing up blood. Correct 1: Yellowish skin is evidence of jaundice, which is secondary to cirrhosis of the liver. Cirrhosis of the liver is a common manifestation of end-stage alcoholic liver disease. Feedback 2: Although facial flushing is a common manifestation in chronic alcohol use disorders, a distinctly butterfly-shaped rash may be indicative of other autoimmune conditions such as lupus erythematosus. Further assessment is warranted. Correct 3: Abdominal distention can be a manifestation of alcoholic hepatitis, cirrhosis of the liver, and pancreatitis, all of which are complications of alcohol use disorder. Further assessment is warranted. Correct 4: Coughing up blood may be evidence of several complications of alcoholism, including esophageal varices, which can culminate in potentially fatal hemorrhage. Further assessment is warranted to evaluate for these as well as other potential causes of coughing up blood. Feedback 5: A complaint of pain or pressure in or behind one's eyes is not directly associated with alcoholism but suggests a potentially emergent concern that requires further assessment.
31. The ED nurse assesses a confused client diagnosed with alcohol use disorder and notes the use of confabulation. Which complication of alcohol use disorder would the nurse suspect? 1) Korsakoff's psychosis 2) Vascular neurocognitive disorder 3) Wernicke's encephalopathy 4) Esophageal varices
1) Korsakoff's psychosis Korsakoff's psychosis is identified by a syndrome of confusion, loss of memory, and confabulation. Confabulation is the creating of imaginary events to fill in memory gaps.
44. Janice is a nurse whose husband is in rehab for alcohol use disorder. While attending a family group, Janice makes several statements about their relationship. Which of these statements would suggest Janice is exhibiting codependent behavior? Select all that apply. 1) "My husband has to accept responsibility for his behavior and the consequences of his drinking." 2) "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." 3) "My father was the same way and I learned it's better just to keep your mouth shut so you don't get hit." 4) "If he didn't have me monitoring his every move he'd probably be dead already." 5) "I need to make sure I'm protecting myself and my children."
2) "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." 3) "My father was the same way and I learned it's better just to keep your mouth shut so you don't get hit." 4) "If he didn't have me monitoring his every move he'd probably be dead already." Feedback 1: This statement is an example of healthy boundaries rather than codependent behavior. Correct 2: People-pleasing, fear of abandonment, and neediness, as evidenced in this statement, are all characteristic codependent behaviors. Correct 3: The sense of helplessness and a history of abuse or neglect as a child are consistent with codependency. Correct 4: This statement suggests an unrealistic need to be in control and may also suggest that Janice's self-worth is rooted in her need to be needed. Both of these are evidence of codependency. Feedback 5: Janice's expression of concern for her own safety and her clear identification of her responsibilities as a parent are examples of healthy rather than codependent behaviors.
35. Which would the nurse consider a priority intervention when planning care for a medically unstable client diagnosed with alcohol use disorder? 1) Simplifying the environment 2) Addressing physical needs 3) Providing opportunities for successful experiences 4) Establishing a trusting interpersonal relationship
2) Addressing physical needs Physical problems must be addressed prior to meeting any psychosocial needs of a client who is medically unstable. According to Maslow's hierarchy of needs, physiological needs should be prioritized over all other needs.
48. A client who is unable to control binge drinking requires increased amounts of alcohol to achieve the same level of intoxication. The client is experiencing marital strife and legal problems. The client's behaviors meet the criteria for which DSM-5 diagnostic category? 1) Dual diagnosis 2) Alcohol use disorder 3) Neurocognitive disorder 4) Alcohol intoxication
2) Alcohol use disorder This client has developed tolerance, cannot control alcohol intake, and has continued use despite persistent problems related to drinking. These symptoms meet the criteria for the diagnosis of alcohol use disorder in the DSM-5.
33. Which client and family teaching is most important regarding the cause of substance addiction? 1) An individual's social and cultural environment can be implicated in the cause of substance addiction. 2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction. 3) Evidence of a genetic link accounts for most cases of substance addiction. 4) Reinforcing properties of the substance encourage progression from use to addiction.
2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction.
43. The nurse is assessing a client who is a substance abuser. The client states, "I use it every day, but it rarely interferes with my work." The nurse determines that the client is using which defense mechanism? 1) Projection 2) Denial 3) Reaction formation 4) Displacement
2) Denial Denial is characterized by avoidance of disagreeable realities and unconscious refusal to acknowledge a thought, feeling, need, or desire. By stating that alcohol use rarely interferes with his or her work, the client is denying a substance abuse problem.
45. Which primary factor is critical in maintaining abstinence for the client diagnosed with alcohol use disorder? 1) Attendance at Alcoholics Anonymous (AA) meetings 2) Personal commitment to change 3) Family involvement 4) Compliance with pharmacological therapy
2) Personal commitment to change The first step in the recovery process necessitates that the client accepts ownership of the problem and establish a behavioral change commitment to continued abstinence.
Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? A. Darken the room to reduce stimuli in order to prevent seizures. B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system. D. Teach the negative effects of alcohol on the body.
ANS: B Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.
A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."
ANS: A, C A. A diet rich in protein will promote hepatic healing." C. "In this condition, blood accumulates in the abdominal cavity." The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.
A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."
ANS: B A positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.
In assessing a client diagnosed with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)
ANS: B If large doses of central nervous system (CNS) depressants (like Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.
A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine
ANS: C Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.
A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."
ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.
37. Paula is attending an education class on addictive disorders. She suspects that her husband may be abusing opiates since he has been taking pills given to him by his brother and she knows the brother had been taking oxycodone for back pain. She asks the nurse how to interpret her husband's behaviors. Which of the following observations by Paula are consistent with opioid intoxication? Select all that apply. 1) "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." 2) "Last night he went out without a coat on and it was 15 degrees outside." 3) "While we were talking at dinner his speech was rapid and he seemed hyperalert to everything in the environment." 4) "He's been having trouble remembering things." 5) "Sometimes it looks like his pupils are very small."
Correct: 1, 2, 4, 5 1) "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." 2) "Last night he went out without a coat on and it was 15 degrees outside." 4) "He's been having trouble remembering things." 5) "Sometimes it looks like his pupils are very small." Correct 1: One manifestation of opioid intoxication is an initial period of euphoria followed by apathy, which is indicated by her statement that "sometimes he acts like he doesn't care about anything." Correct 2: Going outside without a coat in subfreezing weather could be inferred as impaired judgment, which is consistent with opioid intoxication. Feedback 3: Rapid speech and hypervigilance are more consistent with stimulant intoxication. In opioid intoxication, one would expect to see mental cloudiness. Correct 4: Impairment in attention and memory is consistent with opioid intoxication. Correct 5: Paula is describing pupillary constriction, which is consistent with opioid intoxication.
40. Which issues influence an individual's predisposition to substance-related disorders? Select all that apply. 1) Genetic history 2) Fixation at the oral stage of psychosexual development 3) Punitive ego 4) Personality traits 5) Behavior modeling
Correct: 1, 2, 4, 5 1) Genetic history 2) Fixation at the oral stage of psychosexual development 4) Personality traits 5) Behavior modeling Correct 1: Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism. Correct 2: Theories of psychosexual development state that anxiety in people fixated at the oral stage may be reduced by their consumption of substances such as alcohol. Feedback 3: A psychodynamic approach to the etiology of substance abuse focuses on a punitive superego, not ego. According to psychodynamic theory, individuals with punitive superegos turn to alcohol to diminish unconscious anxiety. Correct 4: Certain personality traits, such as low self-esteem, depression, and passivity, are thought to increase a tendency toward addictive behavior. Correct 5: Studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance use.
