Substance Use Disorders in Acute Care

Which patient statement indicates additional education on how to avoid future cold-related problems is required? "I will always dress in multiple layers." "I should wear a hat to protect my head." "I will make sure to have low-carbohydrate foods with me." "I will develop a survival plan just in case."

"I will make sure to have low-carbohydrate foods with me."

Which information would the nurse include when providing education to the community about the effects of alcohol? Select all that apply. One, some, or all responses may be correct. "Tolerant persons usually drink without obvious impairment." "When drinking the same amount of alcohol, women have higher blood alcohol concentration (BAC) levels than men." "The nondependent person can perform complex tasks at higher blood alcohol levels than the tolerant person." "BAC predicts the effects in the nondependent person." "Alcohol affects only the cells of the liver."

"Tolerant persons usually drink without obvious impairment." "When drinking the same amount of alcohol, women have higher blood alcohol concentration (BAC) levels than men." "BAC predicts the effects in the nondependent person."

Injury resulting from direct tissue damage or the release of lethal toxins Occurs when a person becomes hypoxic following immersion in a liquid Localized or systemic injuries whose predisposing factors include age Thermoregulatory mechanisms cannot compensate for temperature changes

- bites and stings - submersion injury - cold related emergency - heat related emergency

Which amount in fluid ounces constitutes 1 drink of 80-proof alcohol spirits? 1 1.5 2 2.5

1.5

Which time frame after the last drink would the nurse assess a patient for alcohol withdrawal delirium? 1 to 2 days 2 to 3 days 12 hours 6 hours

2 to 3 days

People over age 60 account for % of all emergency department visits.

20

Which score on the Drug Abuse Screening Test (DAST-10) is indicative of a substantial problem? 3 points for a male 8 points for a male 9 points for a female 12 points for a female

8 points for a male

Which patient would an emergency department nurse assign a level of 2 using the 5-level ESI triage system? A patient under cardiac arrest A patient with abdominal pain A patient with cold symptoms A patient with chest pain from ischemia

A patient with chest pain from ischemia

Which statement regarding assessment of nontrauma patients in the emergency department is accurate? A primary survey is followed by a focused assessment. A primary and secondary survey is performed. Only a primary survey is performed. A focused assessment is followed by a primary survey.

A primary survey is followed by a focused assessment.

Which intervention is included in the "5 As" tobacco use disorder (TUD) intervention tool? Select all that apply. One, some, or all responses may be correct. Align: Identify all tobacco users at every contact. Advise: Strongly urge all tobacco users to quit. Assist: Develop a plan with the patient to help the patient quit (e.g., counseling, medication). Arrange: Schedule follow-up contact. Acquit: Find a pattern of patient's substance use.

Advise: Strongly urge all tobacco users to quit. Assist: Develop a plan with the patient to help the patient quit (e.g., counseling, medication). Arrange: Schedule follow-up contact.

Which statement about stimulant use is accurate? Amphetamines are not highly addictive. Amphetamines have no role in health care. All stimulants increase cardiac activity. Few people use stimulants as prescribed.

All stimulants increase cardiac activity.

Which impact do drugs associated with substance use disorder (SUD) have on a patient's health? Receiving acute care for problems associated with substance use is rare. Almost every drug associated with substance use causes harm to tissue or organs. Damage is limited to the cardiovascular system. Patients with SUD cause injuries but do not sustain them.

Almost every drug associated with substance use causes harm to tissue or organs.

Which biologic agent can be treated with antibiotics? Smallpox Anthrax Botulism Hemorrhagic fever

Anthrax

Which factor would the nurse consider when assessing a patient with substance abuse? Laboratory work is not helpful in making a diagnosis. The last time the patient used the substance is not relevant to care. Observe for a behavioral problem, like fatigue and insomnia. Ask about all substances that the patient may have used.

Ask about all substances that the patient may have used.

Which nursing action would the nurse perform when assessing a patient's extremities during a secondary survey? Determine ability to void. Assess quality and symmetry of peripheral pulses. Look for symmetry of abdominal wall and bony structures. Palpate for bony crepitus and subcutaneous emphysema.

Assess quality and symmetry of peripheral pulses.

Which prescribed action would the nurse perform first if gastric lavage and activated charcoal are ordered for an unconscious patient who is in the emergency department after ingesting 30 lorazepam (Ativan) tablets? Insert a large bore orogastric tube. Assist with intubation of the patient. Prepare a 60-mL syringe with saline. Give first dose of activated charcoal.

Assist with intubation of the patient.

Which assessment would be most important for the nurse to perform during the observation period of a 22-year-old patient who is admitted after a drowning accident in a local pool and is awake and breathing spontaneously? Auscultate heart sounds. Palpate peripheral pulses. Auscultate breath sounds. Assess mental orientation.

Auscultate breath sounds.

Which drug would the nurse administer to help a patient prevent the alcohol withdrawal symptom of delirium? Benzodiazepines β-Blockers Naloxone Flumazenil

Benzodiazepines

Which statement describes the use of pharmacologic smoking cessation aids? Nicotine replacement therapy is only offered to patients during hospitalization who do not want to quit smoking. Varenicline action on nicotinic receptors is antagonistic only. The primary action of varenicline is to reduce weight gain from smoking cessation. Bupropion reduces the urge to smoke and withdrawal symptoms.

Bupropion reduces the urge to smoke and withdrawal symptoms.

Which partner in emergency preparedness is an extension of first responder services? FEMA CERTs NIMS NDMS

CERTs

Which population is at greatest risk for seeking emergency care related to drowning? Children under 4 years of age Males between the ages of 15 and 25 An elderly male patient experiencing a stroke Individuals who have not taken swimming lessons

Children under 4 years of age

Which statement describes the effects of alcohol on the body? Alcohol causes damage and dysfunction just to the liver. Binge drinking does not have effects on the body other than intoxication. There is little effect on the skin and external tissue from alcohol. Complex effects on neurons in the central nervous system (CNS) are caused by alcohol.

Complex effects on neurons in the central nervous system (CNS) are caused by alcohol.

Which information would the nurse include when teaching a patient about what to expect during stimulant withdrawal? Most patients during an abrupt cessation experience a "buzz." Most patients will be experiencing a life-threatening emergency. Cravings usually resolve within hours after use of the drug subsides. Cravings are intense during the initial period of withdrawal.

Cravings are intense during the initial period of withdrawal.

Which characteristic describes the use of nicotine? Causes central nervous system (CNS) depression Lasts 1 to 2 days in the system Creates a feeling of "high" or a "buzz" Creates feelings of relaxation and euphoria during withdrawal

Creates a feeling of "high" or a "buzz"

Which factor makes older adults more prone to evaporative heat loss? Acute medical problems Decreased body fat Increased energy reserves Increased shivering response

Decreased body fat

Which nursing action demonstrates that the emergency room nurse understands the principles of emergency nursing? Immediately following triage, the nurse conducts a focused assessment on a patient. During the primary survey, the nurse begins by assessing airway, breathing, and circulation. The nurse conducts a secondary survey on a patient who presents with a nontrauma event. While conducting a primary survey, the nurse attempts to identify all injuries through collection of history, head-to-toe assessment, and inspection of posterior surfaces.

During the primary survey, the nurse begins by assessing airway, breathing, and circulation.

Which Emergency Survey Index (ESI) level would a nurse assign to a patient with severe respiratory distress? ESI-1 ESI-2 ESI-3 ESI-4

ESI-1

Which factor contributes to the problems associated with caffeine? Most people use it to promote wakefulness. It is weak in comparison to other stimulants. Caffeine can be used to treat headaches. Energy drinks have high doses of caffeine.

Energy drinks have high doses of caffeine.

Which terror tactic would cause penetrating injuries? Biologic Chemical Nuclear Explosive events

Explosive events

Which principle is the nurse implementing when conducting a musculoskeletal assessment to collect data about a patient's mobility and any signs or symptoms of musculoskeletal injury or conditions? Triage Primary survey Focused assessment Patient care and evaluation

Focused assessment

Which procedure would the nurse plan for a patient with blunt abdominal trauma from a motor vehicle collision who reports increasing abdominal pain? Chest x-ray Focused-abdominal sonography Pelvis palpation Eye exam

Focused-abdominal sonography

Which action would the nurse implement for a patient who arrives in the emergency department several hours after taking "25 to 30" acetaminophen (Tylenol) tablets? Give N-acetylcysteine. Discuss the use of chelation therapy. Start oxygen using a non-rebreather mask. Have the patient drink large amounts of water.

Give N-acetylcysteine.

Which injury causes the most deaths from traumatic brain injury (TBI)? Stab wounds Motor vehicle accidents Occupational accidents Gunshot wounds

Gunshot wounds

Which patient problem is most commonly encountered by the health care team in the emergency department? Select all that apply. One, some, or all responses may be correct. Fever Headache Poisoning Chest pain Abdominal pain

Headache Chest pain Abdominal pain

Which environmental condition predisposes people to heat-related emergencies? Cold temperatures Rain High humidity High barometric pressure

High humidity

Which potential life-threatening circulation problem may be found during the primary survey? Inhalation injury Pneumothorax Hypothermia Stroke

Hypothermia

Which statement reflects the priority goal for the health care team caring for a patient in the emergency room setting? Monitoring the patient Promoting patient safety Providing patient education Identifying a patient in crisis

Identifying a patient in crisis

Which treatment is most effective for heatstroke? Spraying with cool water Applying ice packs Immersing in cold water Applying a moist sheet

Immersing in cold water

Which factor is included in the general criteria to identify patients with substance use disorder (SUD)? Select all that apply. One, some, or all responses may be correct. Impaired control Cognitive impairment Social impairment Dependence Reflective analysis

Impaired control Social impairment Dependence

Which competency is essential for the health care team providing care in an emergency situation? Select all that apply. One, some, or all responses may be correct. Making referrals for follow-up care Implementing appropriate interventions Recognizing patients who need rapid care Providing education to prevent future problems Providing emotional support for the patient's family members

Implementing appropriate interventions Recognizing patients who need rapid care

Which statement about inhalant use is accurate? Long-term use causes no real damage to the brain. Inhalant toxicity is usually not life-threatening. Most inhalants are stimulants similar to methamphetamine. Toxicity can last for days and weeks.

Inhalant toxicity is usually not life-threatening.

Which action would the nurse include in the plan of care after the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest and for whom targeted temperature management (TTM) therapeutic hypothermia is ordered? Initiate cooling per protocol. Avoid the use of sedative drugs. Check mental status every 15 minutes. Rewarm if temperature is below 91°F (32.8°C).

Initiate cooling per protocol.

Which symptom is associated with cannabis withdrawal? Select all that apply. One, some, or all responses may be correct. Insomnia Somnolence Anxiety Anorexia Irritability Nausea

Insomnia Anxiety Anorexia Irritability

Which benefit comes from knowing the severity of a patient's substance use disorder (SUD)? It reflects how long the patient has used the substance. It determines if the substance is still in the patient's system. It allows the health care team to customize treatment. It is only helpful to the psychiatric team.

It allows the health care team to customize treatment.

Which statement regarding the effects of alcohol ingestion is accurate? Toxicity usually occurs with very low blood alcohol levels. There is little impact on electrolytes with alcohol toxicity. The antidote for alcohol should be administered immediately. Lack of coordination can lead to secondary injury.

Lack of coordination can lead to secondary injury.

Which mnemonic would a nurse use to obtain details of a patient's prehospital report of an incidence or illness? SAMPLE MIST AVPU VIPP

MIST

Which health problem might be seen in a patient with substance use disorder (SUD) reflecting personal neglect? Blood clots Malnutrition Chronic sinusitis Hepatitis

Malnutrition

Which role would the nurse take in the acute care setting for a patient who is suspected to have a substance use disorder (SUD)? Select all that apply. One, some, or all responses may be correct. Plan group therapy Manage acute withdrawal Teach and motivate behavior change Refer to treatment/rehab facilities Act as a mentor

Manage acute withdrawal Teach and motivate behavior change Refer to treatment/rehab facilities

Which phrase would the nurse use to document a 15-year-old student who drinks alcohol with friends occasionally? Mild substance use Juvenile substance use Established substance use Unconfirmed substance use

Mild substance abuse

Bites from exotic snakes often cause damage by which method of action? Neurotoxicity Cytotoxicity Vasoactivity Hemolysis

Neurotoxicity

Which drug causes an increased risk for cold-related injury? Phenothiazines Anticholinergics Antihistamines Nicotine

Nicotine

Which information would the nurse include when teaching school students about the use of nicotine? Smokeless tobacco in the form of vaping is the most common method of nicotine use. Nicotine is a central nervous system stimulant. Smoked tobacco is the least harmful form of nicotine. The way a person feels when they use nicotine does not contribute to addiction.

Nicotine is a central nervous system stimulant.

During the primary survey, which action would the nurse take for a patient who is unconscious after a fall from a ladder and is transported to the emergency department by emergency medical personnel? Obtain laboratory tests. Auscultate bowel sounds. Obtain a Glasgow Coma Scale (GCS) score. Ask about chronic medical conditions.

Obtain a Glasgow Coma Scale (GCS) score.

Which therapy is commonly used in patients with opioid withdrawal? Select all that apply. One, some, or all responses may be correct. Ondansetron Nonsteroidal anti-inflammatory drugs (NSAIDs) Acetaminophen Antihistamines Methadone Clonidine

Ondansetron Nonsteroidal anti-inflammatory drugs (NSAIDs) Acetaminophen Antihistamines Methadone Clonidine

Which substance is considered a depressant? Nicotine Opioids Cocaine Caffeine

Opioids

Which action may be the first positive step in the grieving process for families whose loved one died in the emergency department (ED)? Autopsy Collect personal belongings Organ donation Contact the coroner

Organ donation

Which problem is most concerning in regards to the use of depressants? Dependence Overdose Tolerance Withdrawal

Overdose

Which patient problem do nurses most commonly encounter in the emergency department? Pain Fever Poisoning Minor injuries

Pain

A patient with which condition would be assigned the highest priority for treatment for an emergency department triage nurse who is assessing 4 victims involved in a motor vehicle collision? No pedal pulses Open femur fracture Bleeding facial lacerations Paradoxical chest movement

Paradoxical chest movement

Which infectious organism is most common from dog and cat bites? Staphylococcus Pasteurella Crotalidae Streptococcus

Pasteurella

Which assessment is often overlooked during secondary survey? Inspection and palpation of the chest Assessment of head, neck, and face Pelvis inspection and palpation Posterior surface inspection

Posterior surface inspection

Which statement about opioid abuse is accurate? Select all that apply. One, some, or all responses may be correct. Prescription opioids are useful in treating some medical problems. Pleasurable effects such as euphoria promote misuse. Misusing oxycodone or fentanyl is not as harmful as heroin. Dependency occurs only with the misuse of illegal drugs. Opioids affect the central nervous system (CNS), causing stimulation and anxiety.

Prescription opioids are useful in treating some medical problems. Pleasurable effects such as euphoria promote misuse.

Which component would the nurse include when implementing health promotion for patients with substance use? Select all that apply. One, some, or all responses may be correct. Prevention Mentoring Early detection Referral Teaching Sponsoring

Prevention Early detection Referral Teaching

Which assessment finding indicates that a patient is experiencing heat exhaustion? Profuse sweating Hot, dry skin Severe muscle contractions Tachypnea

Profuse sweating

Which action would the nurse take first when using the SBIRT approach? Quickly screen for potential substance abuse disorder. Refer potential users to treatment. Perform an in-depth substance use assessment. Provide education about risks of substance use.

Quickly screen for potential substance abuse disorder.

Which color tag would indicate to the nurse that the patient should be assessed first following an earthquake, after patients are triaged by emergency medical personnel and transported to the emergency department? Red Green Black Yellow

Red

Which assessment finding would the nurse recognize as needing immediate intervention in a patient with alcohol intoxication? Respiratory and circulatory failure Nausea and vomiting Irritability and anxiety Alteration in level of consciousness

Respiratory and circulatory failure

Which effect would cause the nurse to suspect that a patient is experiencing stimulant toxicity? Select all that apply. One, some, or all responses may be correct. Seizures Hypotension Paranoia Fever Confusion Lethargy

Seizures Paranoia Fever Confusion

Which information would the nurse include when teaching a patient about the use of nicotine patches? A patch is good for 2 to 3 days per dose. The patches can be used for up to 6 months. Side effects include insomnia, nausea, and headache. Patches are placed on the same body area with each application.

Side effects include insomnia, nausea, and headache.

Which body part is affected by superficial frostbite? Skin Muscle Bone Tendon

Skin

Which intervention would the nurse include when caring for a patient who has died after experiencing a myocardial infarction? Encourage the family to say goodbye to the patient quickly to help avoid any sad feelings. Tell the family that the hospital will send the patient's belongings to their house. Speak to the family about organ donation. Encourage the family to have an autopsy performed.

Speak to the family about organ donation.

Which intervention occurs during the exposure and environmental control assessment during primary survey? Stabilize any impaled objects. Remove or suction any foreign bodies. Give supplemental O2 via appropriate delivery systems. Give blood products if ordered.

Stabilize any impaled objects.

Which statement about caring for gerontologic patients with substance abuse issues is accurate? Older adults are more likely to binge drink than younger users. Substance use problems often go untreated. Due to physiologic changes, toxicity occurs at higher substance levels. Withdrawal is less severe than in younger patients.

Substance use problems often go untreated.

The nurse would prioritize which assessment for a patient 48 hours into stimulant withdrawal? Glucose level Insomnia Suicidal ideology Fever

Suicidal ideology

Which vaccination would the nurse anticipate giving a 19-year-old patient who is brought to the emergency department with multiple lacerations and tissue avulsion of the left hand and denies having any previous tetanus vaccinations? Tetanus immunoglobulin (TIG) only TIG and tetanus-diphtheria toxoid (Td) Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) only TIG and Tdap

TIG and Tdap

The nurse would recommend which smoking cessation intervention as it is likely to help patients succeed? Working independently to a self-design a cessation plan Taking part in an organized cessation support program Keeping tobacco products around to remind the patient that they are quitting Using tobacco products with the nicotine patch or gum to enhance their effects

Taking part in an organized cessation support program

Which intervention would the nurse include when caring for a patient who is experiencing sedative-hypnotic withdrawal? Select all that apply. One, some, or all responses may be correct. Tapering doses of long-acting benzodiazepine Restricting dietary and fluid intake for electrolyte management Frequent reassuring and orienting the patient Administering laxatives to support GI passing of intoxicating substance Closely monitoring vital signs

Tapering doses of long-acting benzodiazepine Frequent reassuring and orienting the patient Closely monitoring vital signs

Which function is the primary purpose of nicotine replacement therapy? To provide oral stimulation to help distract from smoking To reduce withdrawal symptoms and cravings To enhance abrupt reduction in the nicotine the patient receives To be utilized solely in the acute care facility where smoking isn't allowed

To reduce withdrawal symptoms and cravings

Which patient finding would the nurse recognize as an early sedative-hypnotic withdrawal symptom? Select all that apply. One, some, or all responses may be correct. Tremors Depression Increased sleep Fever Disorientation

Tremors Fever Disorientation

Which object would be used to remove a tick? Nail polish Hot match Petroleum jelly Tweezers

Tweezers

Which consideration would the nurse keep in mind when caring for a patient with depressant toxicity? Overdose produces high blood pressure with a low heart rate. Unintentional overdose often occurs when depressants are taken with alcohol. Clinical findings include restlessness and hyperalertness. Central nervous system (CNS) symptoms include pupillary dilation.

Unintentional overdose often occurs when depressants are taken with alcohol.

Which action would the nurse take first when caring for a patient with a tick bite? Check the vital signs, including temperature. Give doxycycline (Vibramycin) 100 mg orally. Obtain information about recent outdoor activities. Use tweezers to remove any remaining ticks.

Use tweezers to remove any remaining ticks.

Which initial intervention is an active external method for managing hypothermia? Warm water immersion Removing wet clothing Providing warmed IV fluids Radiant lights

Warm water immersion

The nurse would anticipate orders to administer thiamine to a patient undergoing alcohol withdrawal to prevent which complication? Seizures Hypermagnesemia Wernicke-Korsakoff syndrome Hypoglycemia

Wernicke-Korsakoff syndrome