Module 8 Substance-Related Disorders
Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization: a: "The program's support will help me stay sober if I work the program." b. "I'll dry out in AA, then I can have a social drink now and then. c. "AA is for people who have reached the bottom." d. "If I lose my job AA will help me find another."
A
Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he has been a heavy drinker for a number of years. Lab report reveals BAL of 250 mg/dl (.25 g/dl) He is placed on chemical addiction unit for detox. When would the first signs of alcohol withdrawal symptoms be expected to occur? A. Several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink
A
Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he has been a heavy drinker for a number of years. Lab report reveals BAL of 250 mg/dl (.25 g/dl). He is placed on chemical addiction unit for detox. When was the first signs of alcohol withdrawal symptoms be expected to occur? a. several hours after the last drink b. 2 to 3 days after his last drink c. 4 to 5 days after the last drink d. 6 to 7 days after the last drink
A
ReVia (naltrexone) is used for the treatment of alcohol and opioid addiction. A. True B. False
A
The effects of CNS depressant are additive with one another. A. True B. False
A
Which statement most accurately describes substance addiction? a. It is a lack of control over use. Tolerance, craving, and withdrawal symptoms occur when intake is reduced or stopped. b. It occurs when psychoactive drug use interferes with the action of competing neurotransmitters. c. Symptoms occur when two or more drugs that affect the central nervous system (CNS) have additive effects. d. It involves using a combination of substances to weaken or inhibit the effect of another drug.
A Addiction involves a lack of control over substance use, as well as tolerance, craving, and withdrawal symptoms when intake is reduced or stopped.
When planning a substance abuse information program for a local university, the nurse will prioritize which screening? a. Alcohol b. Stimulants c. Hallucinogens d. Inhalants
A Alcohol use disorder is the most common substance-use problem in the United States. The prevalence of alcohol use in the United States affects approximately 16.6 million people. While the other options identify substances being abused within our population, none are as prevalent as is alcohol abuse.
The treatment team plans care for a person diagnosed with schizophrenia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning? a. Consider each disorder primary and provide simultaneous treatment. b. The person will benefit from treatment in a residential treatment facility. c. Withdraw the person from cannabis, and then treat the schizophrenia. d. Treat the schizophrenia first, and then establish the goals for the treatment of substance abuse.
A Dual diagnosis (co-occurring disorders) clinical practice guidelines for both outpatient and inpatient settings suggest that the substance disorder and the psychiatric disorder should both be considered primary and receive simultaneous treatments. Residential treatment may or may not be effective.
A nurse with a history of narcotic abuse is found unconscious in the hospital locker room after overdosing. The nurse is transferred to an inpatient substance abuse unit for care. Which attitudes or behaviors by nursing staff may be enabling? a. Conveying understanding that pressures associated with nursing practice underlie substance abuse. b. Pointing out that work problems are the result, but not the cause, of substance abuse. c. Conveying empathy when the nurse discusses fears of disciplinary action by the state board of nursing. d. Providing health teaching about stress management.
A Enabling denies the seriousness of the patients problem or supports the patient as he or she shifts responsibility from self to circumstances. The incorrect options are therapeutic and appropriate.
In the emergency department, a patients vital signs are: blood pressure (BP), 66/40 mm Hg; pulse (P), 140 beats per minute (bpm); and respirations (R), 8 breaths per minute and shallow. The patient overdosed on illegally obtained hydromorphone (Dilaudid). Select the priority outcome. a. Within 8 hours, vital signs will stabilize as evidenced by BP greater than 90/60 mm Hg, P less than 100 bpm, and respirations at or above 12 breaths per minute. b. The patient will be able to describe a plan for home care and achieve a drug-free state before being released from the emergency department. c. The patient will attend daily meetings of Narcotics Anonymous within 1 week of beginning treatment. d. The patient will identify two community resources for the treatment of substance abuse by discharge.
A Hydromorphone (Dilaudid) is an opiate drug. The correct answer is the only one that relates to the patients physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The distractors are desired outcomes later in the plan of care.
A patient in an alcohol treatment program says, I have been a loser all my life. Im so ashamed of what I have put my family through. Now, Im not even sure I can succeed at staying sober. Which nursing diagnosis applies? a. Chronic low self-esteem b. Situational low self-esteem c. Disturbed personal identity d. Ineffective health maintenance
A Low self-esteem is present when a patient sees himself or herself as inadequate. It is a chronic problem because it is a lifelong feeling for the patient. Data are not present to support the other options.
Select the nursing intervention necessary after administering naloxone (Narcan) to a patient experiencing an opiate overdose. a. Monitor the airway and vital signs every 15 minutes. b. Insert a nasogastric tube and test gastric pH. c. Treat hyperpyrexia with cooling measures. d. Insert an indwelling urinary catheter.
A Narcotic antagonists such as naloxone quickly reverse CNS depression; however, because the narcotics have a longer duration of action than antagonists, the patient may lapse into unconsciousness or require respiratory support again. The incorrect options are measures unrelated to naloxone use.
In what significant ways is the therapeutic environment different for a patient who has ingested D-lysergic acid diethylamide (LSD) than for a patient who has ingested phencyclidine (PCP)? a. For LSD ingestion, one person stays with the patient and provides verbal support. For PCP ingestion, a regimen of limited contact with staff members is maintained, and continual visual monitoring is provided. b. For PCP ingestion, the patient is placed on one-on-one intensive supervision. For LSD ingestion, a regimen of limited interaction and minimal verbal stimulation is maintained. c. For LSD ingestion, continual moderate sensory stimulation is provided. For PCP ingestion, continual high- level stimulation is provided. d. For LSD ingestion, the patient is placed in restraints. For PCP ingestion, seizure precautions are implemented.
A Patients who have ingested LSD respond well to being talked down by a supportive person. Patients who have ingested PCP are very sensitive to stimulation and display frequent, unpredictable, and violent behaviors. Although one person should perform care and talk gently to the patient, no one individual should be alone in the room with the patient. An adequate number of staff members should be gathered to manage violent behavior if it occurs.
When working with a patient beginning treatment for alcohol abuse, what is the nurses most therapeutic approach? a. Empathetic, supportive b. Strong, confrontational c. Skeptical, guarded d. Cool, distant
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.
Which documentation indicates that the treatment plan for a patient in an alcohol treatment program was effective? a. Is abstinent for 10 days and states, I can maintain sobriety one day at a time. Spoke with employer, who is willing to allow the patient to return to work in three weeks. b. Is abstinent for 15 days and states, My problems are under control. Plans to seek a new job where co- workers will not know history. c. Attends AA daily; states many of the members are real alcoholics and says, I may be able to help some of them find jobs at my company. d. Is abstinent for 21 days and says, I know I cant handle more than one or two drinks in a social setting.
A The answer reflects the AA beliefs. The incorrect options each contain a statement that suggests early relapse.
A patient was admitted last night with a hip fracture sustained in a fall while intoxicated. The patient points to the Bucks traction and screams, Somebody tied me up with ropes. The patient is experiencing: a. an illusion. b. a delusion. c. hallucinations. d. hypnagogic phenomenon.
A The patient is misinterpreting a sensory perception when seeing a noose instead of traction. Illusions are common in early withdrawal from alcohol. A delusion is a fixed, false belief. Hallucinations are sensory perceptions occurring in the absence of a stimulus. Hypnagogic phenomena are sensory disturbances that occur between waking and sleeping.
When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After one year of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur? a. Tolerance develops. b. The alcohol is less potent. c. Antagonistic effects occur. d. Hypomagnesemia develops.
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 would account for this change.
A patient has been prescribed the medication Antabuse (disulfiram). The nurse should caution the person that ingesting any alcohol will cause severe: a. Hypertension b. Nausea c. Diarrhea d. Constipation
B
A patient has been referred to Alcoholics Anonymous (AA). The nurse should explain to the person that one of the therapeutic elements of AA is: a. Providing one-on-one cognitive therapy b. Focusing on abstinence and one's loss of control about drinking c. Providing psychoeducation about the treatment therapies d. Allowing clients to be codependent for as long as necessary
B
A patient is in the detoxification unit for abuse of heroin. The nurse should explain to the person that opiate addiction is frequently treated with which medication? a. Buspar (buspirone) b. Dolophine (methadone) c. Halcion (triazolam) d. Thorazine (chlorpromazine)
B
A patient tells a nurse that she has quit drinking coffee because caffeine was making her nervous. The nurse should explain to the person that a common withdrawal symptom is: a. Tremors b. Headaches c. Tachycardia d. Nystagmus
B
CNS depressants are not capable of producing physiological addiction. A. True B. False
B
When a patient requires larger doses of a given medication to maintain its therapeutic effect, the nurse determines that the person has developed: a. Sensitivity b. Tolerance c. Functionality d. Allergies
B
When administered for a heroin overdose, the planned effect of Narcan (naloxone hydrochloride) is to: a. Decrease analgesia and the comatose state induced by heroin b. Compete with heroin for receptors controlling respiration c. Accelerate the metabolism of heroin and stimulate respiratory centers d. Stimulate cortical sites controlling consciousness and cardiovascular function
B
Police bring a patient to the emergency department after an automobile accident. The patient is ataxic with slurred speech and mild confusion. The blood alcohol level is 400 mg/dl (0.40 mg %). Considering the relationship between behavior and blood alcohol level, which conclusion can the nurse draw? The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has recently ingested both alcohol and sedative drugs.
B A nontolerant drinker would be in a coma with a blood alcohol level of 400 mg/dl (0.40 mg %). The fact that the patient is walking and talking shows a discrepancy between blood alcohol level and expected behavior. It strongly suggests that the patients body has become tolerant to the drug. If disulfiram and alcohol are ingested together, then an entirely different clinical picture would result. The blood alcohol level gives no information about the ingestion of other drugs.
1. A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak? a. Between 0800 and 1000 today (6 to 8 hours after drinking stopped) b. Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped) c. About 0200 on hospital day 3 (72 hours after drinking stopped) d. About 0200 on hospital day 4 (96 hours after drinking stopped)
B Alcohol withdrawal usually begins 6 to 8 hours after cessation or significant reduction of alcohol intake. It peaks between 24 and 48 hours, then resolves or progresses to delirium.
Which nursing diagnosis would likely apply both to a patient diagnosed with schizophrenia as well as a patient diagnosed with amphetamine-induced psychosis? a. Powerlessness b. Disturbed thought processes c. Ineffective thermoregulation d. Impaired oral mucous membrane
B Both types of patients commonly experience paranoid delusions; thus, the nursing diagnosis of Disturbed thought processes is appropriate for both. The incorrect options are not specifically applicable to both.
During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, After discharge, Im sure everything will be just fine. Which remark by the nurse will be most helpful to the spouse? a. It is good that youre supportive of your spouses sobriety and want to help maintain it. b. Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol. c. It will be important for you to structure life to avoid as much stress as possible. You will need to provide social protection. d. Remember that alcoholism is a disorder of self-destruction. You will need to observe your spouses behavior carefully.
B During recovery, patients identify and use alternative coping mechanisms to reduce their reliance on alcohol. Physical adaptations must occur. Emotional responses, formerly dulled by alcohol, are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who should be given anticipatory guidance and accurate information.
Which question has the highest priority when assessing a newly admitted patient with a history of alcohol abuse? a. Have you ever had blackouts? b. When did you have your last drink? c. Has drinking caused you any problems? d. When did you decide to seek treatment?
B Learning when the patient had the last drink is essential to knowing when to begin to observe for symptoms of withdrawal. The other questions are relevant but of lower priority.
A patient has smoked two packs of cigarettes daily for many years. When the patient does not smoke or tries to cut back, anxiety, craving, poor concentration, and headache result. What does this scenario describe? a. Substance abuse b. Substance addiction c. Substance intoxication d. Recreational use of a social drug
B Nicotine meets the criteria for a substance, the criterion for addiction (tolerance) is present, and withdrawal symptoms are noted with abstinence or a reduction of the dose. The scenario does not meet the criteria for substance abuse, intoxication, or recreational use of a social drug.
Select the most appropriate outcome for a patient completing the fourth alcohol detoxification program in one year. Before discharge, the patient will a. use rationalization in healthy ways. b. state, I see the need for ongoing treatment. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.
B The answer refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not provide enough information to know whether anger has been identified as a problem. A trusting relationship, although desirable, would not help the patient maintain sobriety.
Which statement made by a client receiving treatment for a substance abuse problem best indicates an understanding of relapse prevention? a. "A good time always meant being with friends who abused like I did." b. "I abuse when I'm bored or lonely but now I know how to keep busy." c. "My family has helped me so much in staying sober." d. "I want so much to stop abusing."
B The goal of relapse prevention is to help individuals identify their "trigger situations" so that periods of sobriety can be lengthened over time and lapses and relapses are not viewed as total failures. Identifying both the trigger and a plausible strategy makes that option the best one. The remaining options are more associated with the client's feelings about the addiction.
A nurse worked at a hospital for several months, resigned, and then took a position at another hospital. In the new position, the nurse often volunteers to be the medication nurse. After several serious medication errors, an investigation reveals that the nurse was diverting patient narcotics for self-use. What early indicator of the nurses drug use was evident? a. Accepting responsibility for medication errors. b. Seeking to be assigned as a medication nurse. c. Frequent complaints of physical pain. d. High sociability with peers.
B The nurse intent on diverting drugs for personal use often attempts to isolate him- or herself from peers rather than being sociable. The person seeks access to medications. Usually, the person will blame errors on others rather than accepting responsibility.
When considering substance abuse, which individual is at the greatest risk for developing functional deficits in the future? a. The 45 year old with a 10-year history of heroin abuse b. The 15 year old abusing cannabis c. The 60 year old who has been dependent on sedatives for 15 years d. The 28 year old with a cocaine habit
B While the substance abuse identified in all the clients has resulted in some form of dysfunction, the teenager is at greatest risk for developing functional deficients. The brain doesn't fully mature until the mid-twenties; therefore, substances of abuse can interfere with brain ability to function in the future. Ingestion of drugs during youth and teenage years can also interfere with psychological/social growth, decrease the potential for a productive future, and terminate the life span of too many children and teenagers.
A patient has been prescribed ReVia (naltrexone) for treatment of alcohol dependency. After explaining the purpose of the drug, the nurse determines that the instructions have been understood when the person states that ReVia: a. Is a deterrent to impulsively drink alcohol b. Causes severe reactions when alcohol is consumed c. Reduces the cravings for alcohol d. Will improve appetite and nutritional status
C
A patient who has overdosed on heroin has been admitted. The nurse should plan to administer which medication? a. Normeperidine b. Catapres (clonidine) c. Narcan (naloxone) d. ReVia (naltrexone)
C
A patient is admitted in a comatose state after ingesting 30 capsules of pentobarbital sodium. A friend of the patient says, Often my friend drinks, along with taking more of the drug than is prescribed. What is the effect of the use of alcohol with this drug? a. The drugs metabolism is stimulated. b. The drugs effect is diminished. c. A synergistic effect occurs. d. There is no effect.
C Both pentobarbital and alcohol are CNS depressants and have synergistic effects. Taken together, the action of each would potentiate the other.
A newly hospitalized patient has needle tracks on both arms. A friend states that the patient uses heroin daily but has not used in the past 24 hours. The nurse should assess the patient for: a. slurred speech, excessive drowsiness, and bradycardia. b. paranoid delusions, tactile hallucinations, and panic. c. runny nose, yawning, insomnia, and chills. d. anxiety, agitation, and aggression.
C Early signs and symptoms of narcotic withdrawal resemble symptoms of onset of a flulike illness, but without temperature elevation. The incorrect options reflect signs of intoxication or CNS depressant overdose and CNS stimulant or hallucinogen use.
A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse to include in the presentation? a. Older adults require higher doses of a substance to achieve a desired effect. b. Older adults commonly use rationalization to cope with a substance use disorder. c. Older adults are at an increased risk for substance use following retirement. d. Older adults develop substance use to mask manifestations of dementia.
C Retirement and other life change stressors increase the risk for substance use in older adults, especially if there is a prior history of substance use.
A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, Snakes are crawling on my bed. Ive got to get out of here. What is the most accurate assessment of the 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 a recurrence of an acute psychosis.
C Symptoms of agitation, elevated pulse, and perceptual distortions point to alcohol withdrawal delirium, a medical emergency. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? a. Orient the client frequently to time, place, and person. b. Offer fluids and nourishing diet as tolerated. c. Implement seizure precautions. d. Encourage participation in group therapy sessions.
C The greatest risk to the client is injury. Implementing seizure precautions is the priority intervention.
A nurse is caring for a client who hasalcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? a. Chlordiazepoxide b. Bupropion c. Disulfiram d. Carbamazepine
C The nurse should expect to administer disulfiram to help the client maintain abstinence from alcohol.
A patient who was admitted for a heroin overdose received naloxone (Narcan), which improved the breathing pattern. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, I feel terrible. Which analysis is correct? a. The patient is exhibiting a prodromal symptom of seizures. b. An idiosyncratic reaction to naloxone is occurring. c. Symptoms of opiate withdrawal are present. d. The patient is experiencing a relapse.
C The symptoms given in the question are consistent with narcotic withdrawal and result from administration of naloxone. Early symptoms of narcotic withdrawal are flulike in nature. Seizures are more commonly observed in alcohol withdrawal syndrome.
The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential risk for alcohol withdrawal delirium? a. Hypertension, ataxia, hunger b. Stupor, lethargy, muscular rigidity c. Hypotension, course hand tremors, lethargy d. Hypertension, change in level of consciousness, hallucinations
D Hypertension, change in level of consciousness, hallucinationsSymptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, change in consciousness, agitation, fever and delusions.
A patient admitted to an alcoholism rehabilitation program says, Im just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and several drinks during the evening. The patient is using which defense mechanism? a. Rationalization b. Introjection c. Projection d. Denial
D Minimizing ones drinking is a form of denial of alcoholism. The patients own description indicates that social drinking is not an accurate name for the behavior. Projection involves blaming another for ones faults or problems. Rationalization involves making excuses. Introjection involves taking a quality into ones own system.
Which medication is the nurse most likely to see prescribed as part of the treatment plan for both a patient in an alcoholism treatment program and a patient in a program for the treatment of opioid addiction? a. methadone (Dolophine) b. bromocriptine (Parlodel) c. disulfiram (Antabuse) d. naltrexone (Revia)
D Naltrexone is useful for treating both opioid and alcohol addictions. As an opioid antagonist, it blocks the action of opioids. Because it blocks the mechanism of reinforcement, it also reduces or eliminates alcohol craving.
A patient comes to an outpatient appointment obviously intoxicated. The nurse should: a. explore the patients reasons for drinking today. b. arrange admission to an inpatient psychiatric unit. c. coordinate emergency admission to a detoxification unit. d. tell the patient, We cannot see you today because youve been drinking.
D One cannot conduct meaningful therapy with an intoxicated patient. The patient should be taken home to recover and then make another appointment. Hospitalization is not necessary.
To monitor for a significant health risk, the nurse will prepare to implement which intervention for a client admitted for alcohol detoxification? a. 24-hour urine test b. Nutritional consult c. Falls assessment d. Cardiac consult
D Patients with a co-occurring/comorbid dual diagnosis have more severe symptoms, experience more crises, and require longer treatment. Cardiovascular risks are also significant. Alcohol can raise the levels of triglycerides in the blood. Excessive alcohol intake results in stroke, cardiomyopathy, cardiac dysrhythmia, and sudden cardiac death. While the remaining options may not be inappropriate for some clients being admitted for alcohol-related treatment, the cardiac risks are the most significant.
A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled pentobarbital sodium. What is the nurses first action? a. Test reflexes b. Check pupils c. Initiate vomiting d. Establish a patent airway
D Pentobarbital sodium is a barbiturate. Maintaining a patent airway is the priority when the patient is unconscious. Assessing neurologic function by testing reflexes and checking pupils can wait. Vomiting should not be induced when a patient is unconscious because of the danger of aspiration.
Which is an important nursing intervention when giving care to a patient withdrawing from a central nervous system (CNS) stimulant?a. Make physical contact by frequently touching the patient. b. Offer intellectual activities requiring concentration. c. Avoid manipulation by denying the patients requests. d. Observe for depression and suicidal ideation.
D Rebound depression occurs with the withdrawal from CNS stimulants, probably related to neurotransmitter depletion. Touch may be misinterpreted if the patient is experiencing paranoid tendencies. Concentration is impaired during withdrawal. Denying requests is inappropriate; maintaining established limits will suffice.
Which treatment approach is most appropriate for a patient with antisocial tendencies who has been treated several times for substance addiction but has relapsed? a. One-week detoxification program b. Long-term outpatient therapy c. Twelve-step self-help program d. Residential program
D Residential programs and therapeutic communities have goals of complete change in lifestyle, abstinence from drugs, elimination of criminal behaviors, development of employable skills, self-reliance, and honesty. Residential programs are more effective than outpatient programs for patients with antisocial tendencies.
A new patient in an alcoholism rehabilitation program says, Im just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and a few drinks in the evening. Which response by the nurse will help the patient view the drinking more honestly? a. I see, and use interested silence. b. I think you may be drinking more than you report. c. Being a social drinker involves having a drink or two once or twice a week. d. You describe drinking steadily throughout the day and evening. Am I correct?
D The answer summarizes and validates what the patient reported but is accepting rather than strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in treatment.
A patient with a history of daily alcohol abuse says, Drinking helps me cope with being a single parent. Which response by the nurse would help the individual conceptualize the drinking more objectively? a. Sooner or later, alcohol will kill you. Then what will happen to your children? b. I hear a lot of defensiveness in your voice. Do you really believe this? c. If you were coping so well, why were you hospitalized again? d. Tell me what happened the last time you drank.
D The individual is rationalizing. The correct response will help the patient see alcohol as a cause of the problems, not the solution. This approach can also help the patient become receptive to the possibility of change. The incorrect responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurses frustration with the patient.
An adult in the emergency department states, I feel restless. Everything I look at wavers. Sometimes Im outside my body looking at myself. I hear colors. I think Im losing my mind. Vital signs are slightly elevated. The nurse should suspect a: a. cocaine overdose. b. schizophrenic episode. c. phencyclidine (PCP) intoxication. d. D-lysergic acid diethylamide (LSD) ingestion.
D The patient who has ingested LSD 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. PCP use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.
My mother brings daughter to the ED. Daughter was at a dance party for the past many hours, is sweating and does not look well. Temp is now 103 F, teeth grinding and weight loss. What should the nurse's greatest concern? a. poor nutrition-possible eating disorder b. dehydration and electrolyte balance c. influenza with accompanying high fever d. dental problems due to teeth grinding
B
Which statement indicates the existence of a codependent relation between a client diagnosed with substance abuse and their life partner? a. "I'm always so angry about how the addiction controls our lives." b. "Everyone knows about the addiction and it is so very embarrassing." c. "All our savings have been spent on rehab treatment." d. "They are the love of my life but it's so hard living together."
A Codependent individuals find their moods being influenced by the situation and the emotions of the abuser. While the other options reflect common characteristics of a relation involving substance abuse, they do not necessarily demonstrate a codependency.
To assist chemically dependent nurses by securing evaluation, treatment, monitoring, and ongoing support, several state nursing associations have established treatment programs that are termed: a. Chemical dependency programs b. Peer assistance programs c. Nursing substance abuse programs d. Non-punitive support programs
B
A nurse advising a colleague about the Texas Peer Assistance Program for Nurses (TPAPN) should explain that: a. Participation in the program is voluntary. b. Enrollment in TPAPN guarantees a nurse can return to practice. c. TPAPN is designed exclusively for persons with substance abuse problems. d. No one but a TPAPN counselor will know the colleague is in the program.
A
A patient admitted to the detoxification unit following alcohol abuse is diagnosed with delirium tremens. The nurse anticipates that the person will exhibit: a. Tachycardia b. Bradycardia c. Hypotension d. Chills
A
A patient in a detoxification unit for substance abuse is being referred to support group. After explaining the advantages, the nurse determines that the instructions have been understood when the person states that support groups: a. Reduce the sense of isolation b. Focus on immediate issues c. Overcome negative self-thoughts d. Focus on spiritual power to help a patient
A
A patient in the emergency room is experiencing heroin withdrawal. The nurse should assess the person for: a. Abdominal cramps b. Tachycardia c. Constricted pupils d. Tremors
A
A patient has been prescribed Xanax (alprazolam) for anxiety. The nurse should explain to the person that this medication: a. Is non-addictive b. Increases the duration of REM sleep c. May decrease total sleep hours d. Can cause potentially dangerous withdrawal symptoms
D
Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically D. Provide stimulation in environment E. Provide reality orientation as appropriate F. Maintain NPO status
ABCE
Which interventions are most important for caring for a client in alcohol withdrawal? Select all that apply. a. Monitor vital signs b. Provide a safe environment c. Address hallucinations therapeutically d. Provide stimulation in the environment e. Provide reality orientation as appropriate f. Maintain NPO status
ABCE When the client is experiencing withdrawal from alcohol, the priority care is to prevent the client from harming self or others. The nurse would monitor their vitals and report any abnormalities. The nurse would provide a low-stimulating environment to maintain the client in as calm a state as possible. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake need to be maintained.
A client is in the rehabilitative stage of treatment for substance use disorder. When teaching relapse prevention skills, what should the nurse emphasize: select all that apply a. preventing fatigue b. Maintaining physical health c. Suppressing thoughts of returning to substance use d. reducing amount of solitary unstructured time e. reconnecting with the old social network
ABD
Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital, where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply. a. Intermittent supervision is available in inpatient settings. b. He requires stabilization of multiple symptoms. c. He has nutritional and self-care needs. d. Medication adherence will be mandated. e. He is in imminent danger of harming himself.
BCE
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? (Select all that apply.) a. "We need to understand that our sibling is responsible for their disorder." b. "Eliminating codependent behavior will promote recovery." c. "Our sibling should participate in an Al-Anon group to assist with recovery." d. "The primary goal of treatment is abstinence from substance use." e. "Our sibling needs to discuss personal feelings about substance use to help with recovery."
BDE Families should be aware of codependent behavior (enabling) that can promote substance use rather than recovery. Abstinence is the primary treatment goal for a client who has a substance use disorder. Clients must acknowledge their feelings about substance use as part of a substance use recovery program.
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? Select all that apply. a. Bradycardia b. Fine tremors of both hands c. Hypotension d. Vomiting e. Restlessness
BDE Fine tremors of both hands is an expected finding of alcohol withdrawal. Vomiting is an expected finding of alcohol withdrawal. Restlessness is an expected finding of alcohol withdrawal.
A patient is in a detoxification unit due to alcohol abuse and is suffering from withdrawal symptoms. The nurse should explain to the person that one of the withdrawal symptoms is: a. Severe dysphoria b. Agitation c. Vivid dreams d. Tremors
D
Most studies conclude that the etiology of alcoholism is: a. Poor parenting practices b. Antisocial personality disorders c. Obsessive-compulsive disorders d. Genetics and environmental factors
D
A patient has been admitted with acute alcohol withdrawal. The nurse should explain to the person that the antianxiety medication often prescribed is: a. Prozac (fluoxetine) b. Thorazine (chlorpromazine) c. Ativan (lorazepam) d. Haldol (haloperidol)
C
While caring for a patient with a methamphetamine overdose, which tasks are the priorities of care? Select all that apply. a. Administration of naloxone (Narcan) b. Vitamin B12 and folate supplements c. Restoring nutritional integrity d. Prevention of seizures e. Reduction of fever
DE Hyperpyrexia and convulsions are common when a patient has overdosed on a CNS stimulant. These problems are life threatening and take priority. Naloxone (Narcan) is administered for opiate overdoses. Vitamin B12 and folate may be helpful for overdoses from solvents, gases, or nitrates. Nutrition is not a priority in an overdose situation.
A patient asks for information about Alcoholics Anonymous (AA). Which is the nurses best response? a. It is a self-help group with the goal of sobriety. b. It is a form of group therapy led by a psychiatrist. c. It is a group that learns about drinking from a group leader. d. It is a network that advocates strong punishment for drunk drivers.
A AA is a peer support group for recovering alcoholics. The goal is to maintain sobriety. Neither professional nor peer leaders are appointed.
A patient with Wernicke's syndrome has been admitted. The nurse should explain to the person that treatment for this condition is the administration of: a. Thiamine b. Vitamin C c. Riboflavin d. Vitamin K
A
A step and decrease in denial is for the client to see the relationship between substance use and personal problems. A. True B. False
A
Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization: A. "The program's support will help me stay sober if I work the program." B. "I'll dry out in AA, then I can have a social drink now and then. C. "AA is for people who have reached the bottom." D. "If I lose my job AA will help me find another."
A
In substance use disorders, peer feedback is often more excepted and feedback from authority figures. A. True B. False
A
A nurse can assist a patient diagnosed with addiction and the patients family in which aspects of relapse prevention? 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. Isolating self from significant others and social situations until sobriety is established e. Teaching the patient about the physical changes to expect as the body adapts to functioning without substances
ACE 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. The nurse can participate in role playing and help the patient evaluate the usefulness of new strategies. The nurse can also provide valuable information about the physiologic changes that can be expected and the ways in which 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.
Which assessment findings best correlate to the withdrawal from central nervous system depressants? a. Dilated pupils, tachycardia, elevated blood pressure, elation b. Labile mood, lack of coordination, fever, drowsiness c. Nausea, vomiting, diaphoresis, anxiety, tremors d. Excessive eating, constipation, headache
C The symptoms of withdrawal from various CNS depressants are similar. Generalized seizures are possible.
A patient undergoing alcohol rehabilitation decides to accept disulfiram (Antabuse) therapy to avoid impulsively responding to drinking cues. Which information should be included in the discharge teaching for this patient? Select all that apply a. Avoid aged cheeses. b. Read labels of all liquid medications. c. Wear sunscreen and avoid bright sunlight. d. Maintain an adequate dietary intake of sodium. e. Avoid breathing fumes of paints, stains, and stripping compounds.
BE 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, beer, or spirits of any sort may also trigger reactions. The other options do not relate to hidden sources of alcohol.
A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority? a. Check the patient every 15 minutes. b. Rigorously encourage fluid intake. c. Provide one-on-one supervision. d. Keep the room dimly lit.
C This patient is experiencing alcohol withdrawal delirium. One-on-one supervision is necessary to promote physical safety until sedation reduces the patients feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes illusions. Oral fluids are important, but safety is a higher priority.
A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe? a. Monoamine oxidase inhibitor, such as phenelzine (Nardil) b. Phenothiazine, such as thioridazine (Mellaril) c. Benzodiazepine, such as lorazepam (Ativan) d. Narcotic analgesic, such as morphine
C This patient is experiencing alcohol withdrawal delirium. Sedation allows for the safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties. Antidepressant, antipsychotic, and opioid medications will not relieve the patients symptoms.
A patient being treated for alcoholic cirrhosis of the liver tells a nurse that his friends are against him because they warn that his continued drinking could be fatal. Which is the best response by the nurse? a. "Your friends may have problems with their own drinking." b. "It's unfortunate that your friends are being judgmental about your drinking." c. I'm sorry to hear that your friends are not more supportive during your treatment." d. "Your friends are concerned that your drinking has consequences."
D
The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium. A. Hypotension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, coarse hand tremors, lethargy D. Hypertension, changes in level of consciousness, hallucinations
D
A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is: a. jaundiced. b. dependent on alcohol. c. healthy but underweight. d. microcephalic and cognitively impaired.
D Fetal alcohol syndrome is the result of alcohols inhibiting fetal development in the first trimester. The fetus of a woman who drinks that much alcohol will probably have this disorder. Alcohol use during pregnancy is not likely to produce the findings listed in the distractors.
When assessing a patient who has ingested flunitrazepam (Rohypnol), the nurse would expect: a. acrophobia. b. hypothermia. c. hallucinations. d. anterograde amnesia.
D Flunitrazepam is known as the date rape drug. It produces disinhibition and a relaxation of voluntary muscles, as well as anterograde amnesia for events that occur. The other options do not reflect symptoms commonly observed after use of this drug.
Which assessment findings will the nurse expect in an individual who has just injected heroin? a. Anxiety, restlessness, paranoid delusions b. Heightened sexuality, insomnia, euphoria c. Muscle aching, dilated pupils, tachycardia d. Drowsiness, constricted pupils, slurred speech
D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations are decreased, and attention is impaired. The incorrect options describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine abuse.
Which assessment findings support a nurses suspicion that a patient has been using inhalants? a. Pinpoint pupils and respiratory rate of 12 breaths per minute b. Perforated nasal septum and hypertension c. Drowsiness, euphoria, and constipation d. Confusion, mouth ulcers, and ataxia
D Inhalants are usually CNS depressants, giving rise to confusion and ataxia. Mouth ulcers come from the irritation of buccal mucosa by the inhalant. The incorrect options relate to cocaine snorting and opioid abuse.
A patient admitted yesterday for injuries sustained in a fall while intoxicated believes snakes are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injury
D clouded sensorium, agitation, sensory perceptual distortions, and poor judgment increase the risk for injury. Disturbed sensory perception is an applicable diagnosis, but safety has a higher priority. The scenario does not provide data to support the other diagnoses.
