Deck 14: Substance Use and Addictive Disorders

Question 1

The nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 50 attempts within a 15-minute period. Which is the best rationale for assessing this client for substance addiction?

A) Narcotic pain medication is contraindicated for all clients with active substance use disorders.
B) Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.
C) There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance.
D) The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

Answer 1

Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.

Question 2

The nurse holds the hand of a client who is experiencing alcohol withdrawal. The nurse is assessing for which condition?

A) Emotional strength
B) Wernicke-Korsakoff syndrome
C) Tachycardia
D) Coarse tremors

Answer 2

Coarse tremors

Question 3

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the physician to treat this disorder. The nurse would give the client information on which medications?

A) Escitalopram (Lexapro) and clozapine (Clozaril)
B) Citalopram (Celexa) and olanzapine (Zyprexa)
C) Lithium carbonate (Lithobid) and naltrexone (ReVia)
D) Haloperidol (Haldol) and ziprasidone (Geodon)

Answer 3

Lithium carbonate (Lithobid) and naltrexone (ReVia)

Question 4

A client diagnosed with major depression and substance use disorder has an altered sleep pattern and demands a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to first try nonpharmacological interventions?

A) Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance.
B) Sedative-hypnotics decrease the production of needed liver enzymes.
C) Sedative-hypnotics lengthen necessary REM (rapid eye movement, dream) sleep.
D) Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

Question 5

A client with a history of alcohol use disorder is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client sign or symptom should be the nurse's first priority?

A) Hearing and visual impairment
B) Blood pressure of 180/100 mm Hg
C) Mood rating of 2/10 on numeric scale
D) Dehydration

Question 6

Which client statement demonstrates positive progress toward recovery from a substance use disorder?

A) "I have completed detox and therefore am in control of my drug use."
B) "When I can't control my cravings, I will faithfully attend Narcotic Anonymous."
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."

Question 7

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements by nursing students about hepatic encephalopathy indicate successful teaching? (Select all that apply.)

A) "A diet rich in protein will promote hepatic healing."
B) "This condition results from a rise in serum ammonia, leading to impaired mental functioning."
C) "In this condition, an excessive amount of serous fluid 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."

Question 8

A nurse is preparing a staff education session about the impaired nurse and the consequences of this impairment. Which statement by a staff member indicates successful teaching?

A) "The state board of nursing must be notified with subjective documentation of impairment."
B) "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice."
C) "Some state boards of nursing administer the treatment programs themselves, while others refer the nurse to other resources."
D) "After a return to practice, a recovering nurse may be closely monitored for several days."

Question 9

Which medications would the nurse most likely administer to a client who has a history of opiate withdrawal?

A) Haloperidol (Haldol) and acamprosate (Campral)
B) Naloxone (Narcan) and naltrexone (ReVia)
C) Disulfiram (Antabuse) and lorazepam (Ativan)
D) Methadone (Dolophine) and clonidine (Catapres)

Question 10

Which nursing diagnosis is the priority 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

Question 11

Which nursing statements exemplify the process that must be completed by a nurse in the pre-introductory phase prior to caring for clients diagnosed with a substance-related disorder? (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."

Question 12

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler?

A) Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not.
B) Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men.
C) Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course.
D) Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

Question 13

A nurse is reviewing the stat laboratory data of a client 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

Question 14

The client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." The nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97 $\degree$ F (36 $\degree$ C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis?

A) Denial
B) Fluid volume excess
C) Imbalanced nutrition: less than body requirements
D) Ineffective individual coping

Question 15

A client diagnosed with chronic alcohol addiction 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) To immediately attend AA meetings at least weekly.
B) To rely on an AA sponsor to help control alcohol cravings.
C) To incorporate family in AA attendance.
D) To seek appropriate deterrent medications through AA.

Question 16

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year to feel better. Which term should the nurse use in report to best describe this individual's situation?

A) Psychological addiction
B) Codependence
C) Substance induced disorder
D) Intoxication

Question 17

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 response by the nurse is therapeutic?

A) "Why do you assume responsibility for his behaviors?"
B) "I think you should start to confront his behavior."
C) "Your husband needs to deal with the consequences of his drinking."
D) "Do you understand what the term enabler means?"

Question 18

Which client statement indicates a knowledge deficit related to a substance use disorder?

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 lysergic acid diethylamide (LSD) use may reoccur spontaneously."
D) "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

Question 19

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 (AA) meetings in 90 days.
B) Educate the client about the biopsychosocial consequences of alcohol abuse.
C) Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.
D) Provide thiamin supplements to prevent Wernicke-Korsakoff syndrome.

Question 20

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant to a client with alcohol withdrawal?

A) Antagonist treatment
B) Deterrent therapy
C) Codependency therapy
D) Medication-assisted treatment

Question 21

A nursing supervisor is about to meet with a staff nurse suspected of diverting clients' pain medications. Which assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.)

A) Is frequently absent from work
B) Experiences mood swings
C) Makes elaborate excuses for behavior
D) Frequently uses the restroom
E) Has a flushed face

Question 22

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. The nurse would assess which symptoms and behaviors? (Select all that apply.)

A) Stressful situations precipitate gambling behaviors.
B) Anticipation and restlessness can only be relieved by placing a bet.
C) Winning brings about feelings of sexual satisfaction.
D) Gambling is used as a coping strategy.
E) Compulsive gambling began in early adolescence.

Question 23

A nurse is about to meet with a client suffering from codependency. Which data would the nurse expect to find during the assessment of this client? (Select all that apply.)

A) Has a long history of focusing thoughts and behaviors on other people
B) As a child, experienced overindulgent and overprotective parents
C) Is a people pleaser and does almost anything to gain approval
D) Exhibits helpless behaviors but actually feels very competent
E) Can achieve a sense of control through fulfilling the needs of others

Question 24

The concept of ____________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

Question 25

A nursing supervisor is offering an impaired staff member information regarding a peer assistance program. Which facts should the supervisor include? (Select all that apply.)

A) A hot-line number will be available in order to call for help.
B) A verbal contract detailing the method of treatment will be initiated prior to the program.
C) Peer support is provided through regular contact with the impaired nurse.
D) Contact to provide peer support will last for one year.
E) One of the program goals is to intervene early in order to reduce hazards to clients.