Deck 19: Substance Use and Addictive Disorders

Question 1

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 0.50 mg%. Considering the relationship between the behaviour and blood alcohol level, which conclusion is most probable?

A) The patient rarely drinks alcohol.
B) The patient has a high tolerance to alcohol.
C) The patient has been treated with disulfiram (Antabuse).
D) The patient has ingested both alcohol and sedative drugs recently.

Answer 1

The patient has a high tolerance to alcohol.

Question 2

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory centre secondary to narcotic intoxication. Select the priority outcome.

A) The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization.
B) Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.
C) The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department.
D) Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

Answer 2

Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.

Question 3

A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively?

A) "Sooner or later, alcohol will kill you. Then what will happen to your children?"
B) "I hear a lot of defensiveness in your voice. Do you really believe this?"
C) "If you were coping so well, why were you hospitalized again?"
D) "Tell me what happened the last time you drank."

Answer 3

"Tell me what happened the last time you drank."

Question 4

When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred?

A) Tolerance has developed.
B) Antagonistic effects are evident.
C) Metabolism of the alcohol is now delayed.
D) The pharmacokinetics of the alcohol has changed.

Question 5

Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose?

A) Simple and safe
B) Active and bright
C) Stimulating and colourful
D) Confrontational and challenging

Question 6

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?

A) Naloxone (Targin)
B) Methadone (Metadol)
C) Disulfiram (Antabuse)
D) Naltrexone (ReVia)

Question 7

A patient admitted yesterday for injuries sustained while intoxicated believes bugs 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

Question 8

A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defence mechanism?

A) Denial
B) Projection
C) Introjection
D) Rationalization

Question 9

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, and diaphoretic and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation.

A) The patient is attempting to obtain attention by manipulating staff.
B) The patient may have sustained a head injury before admission.
C) The patient has symptoms of alcohol-withdrawal delirium.
D) The patient is having an acute psychosis.

Question 10

A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority?

A) Cardiovascular
B) Respiratory
C) Neurologic
D) Hepatic

Question 11

Select the most therapeutic manner for a nurse to work with a patient who is beginning treatment for alcohol addiction.

A) Empathetic, supportive
B) Skeptical, guarded
C) Cool, distant
D) Confrontational

Question 12

A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response.

A) "The goal of AA is for members to learn controlled drinking with the support of a higher power."
B) "An individual is supported by peers while working through a 12-step plan."
C) "You must make a commitment to permanently abstain from alcohol and other drugs."
D) "You will be assigned a sponsor who will plan your treatment program."

Question 13

During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse?

A) "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."
B) "It will be important for you to structure life to avoid as much stress as you can and provide social protection."
C) "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behaviour carefully."
D) "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

Question 14

A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated?

A) Check the patient every 15 minutes
B) One-on-one supervision
C) Keep the room dimly lit
D) Force fluids

Question 15

Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response.

A) "Alcoholism is a lifelong disease. Relapses are expected."
B) "Use search and destroy tactics to keep the home alcohol-free."
C) "It's important that you visit your family member on a regular basis."
D) "Make your loved one responsible for the consequences of behaviour."

Question 16

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed:
0200: 118/78 mm Hg and 72 beats/min
0400: 126/80 mm Hg and 76 beats/min
0600: 128/82 mm Hg and 72 beats/min
0800: 132/88 mm Hg and 80 beats/min
1000: 148/94 mm Hg and 96 beats/min
What is the nurse's priority action?

A) Force fluids.
B) Consult the health care provider.
C) Obtain a clean-catch urine sample.
D) Place the patient in a vest-type restraint.

Question 17

At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as which of the following?

A) Codependence
B) Assertiveness
C) Role reversal
D) Homeostasis

Question 18

A patient asks for information about Alcoholics Anonymous. Select the nurse's best response.

A) "Alcoholics Anonymous is a form of group therapy led by a psychiatrist."
B) "Alcoholics Anonymous is a self-help group for which the goal is sobriety."
C) "Alcoholics Anonymous is a group that learns about drinking from a group leader."
D) "Alcoholics Anonymous is a network that advocates strong punishment for drunk drivers."

Question 19

The treatment team discusses the plan of care for a patient with concurrent disorders of schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, which of the following should the team do?

A) Provide long-term care for the patient in a residential facility
B) Withdraw the patient from cannabis, and then treat the schizophrenia
C) Consider each diagnosis primary and provide simultaneous treatment
D) First treat the schizophrenia, and then establish goals for substance abuse treatment

Question 20

A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe which of the following?

A) A narcotic analgesic, such as hydromorphone (Dilaudid)
B) A benzodiazepine, such as lorazepam (Ativan) or chlordiazepoxide (Librium)
C) An antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril)
D) A monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil)

Question 21

Which assessment findings are likely for an individual who recently injected heroin?

A) Anxiety, restlessness, paranoid delusions
B) Muscle aching, dilated pupils, tachycardia
C) Heightened sexuality, insomnia, euphoria
D) Drowsiness, constricted pupils, slurred speech

Question 22

A young woman has been admitted to hospital for use of room deodorizers as inhalants. Which is a sign of intoxication from inhaling volatile nitrites such as room deodorizers?

A) Flushing
B) Hallucinations
C) Slurred speech
D) Enhancement of sexual pleasure

Question 23

Select the priority outcome for a depressed patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will do which of the following?

A) State, "I know I need long-term treatment."
B) Use denial and rationalization in healthy ways.
C) Identify constructive outlets for expression of anger.
D) Develop a trusting relationship with one staff member.

Question 24

A patient is thin, tense, and jittery and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely?

A) PCP
B) Heroin
C) Barbiturates
D) Amphetamines

Question 25

Which goal for treatment of alcoholism should the nurse address first?

A) Learn about addiction and recovery.
B) Develop alternate coping strategies.
C) Develop a peer support system.
D) Achieve physiologic stability.

Question 26

An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. Which of the following should the nurse suspect?

A) A schizophrenic episode
B) Hallucinogen ingestion
C) Opium intoxication
D) Cocaine overdose

Question 27

The nurse can assist a patient to prevent substance abuse relapse by doing which of the following? Select all that apply.

A) Rehearsing techniques to handle anticipated stressful situations
B) Advising the patient to accept residential treatment if relapse occurs
C) Assisting the patient to identify life skills needed for effective coping
D) Advising isolating self from significant others until sobriety is established
E) Informing the patient of physical changes to expect as the body adapts to functioning without substances

Question 28

A patient took a large quantity of phenylcyclohexyl piperidine. Priority nursing and medical measures include which of the following? Select all that apply.

A) Administration of naloxone (Narcan)
B) Vitamin B12 and folate supplements
C) Restoring nutritional integrity
D) Management of heart rate
E) Environmental safety

Question 29

Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.

A) Monitor vital signs.
B) Observe for depression.
C) Awaken the patient every 15 minutes.
D) Use warmers to maintain body temperature.

Question 30

A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate?

A) 1-week detoxification program
B) Long-term outpatient therapy
C) 12-step self-help program
D) Residential program

Question 31

Which of the following symptoms of withdrawal from opioids should the nurse assess?

A) Dilated pupils, tachycardia, elevated blood pressure, and elation
B) Nausea, vomiting, diaphoresis, anxiety, and hyperreflexia
C) Mood lability, incoordination, fever, and drowsiness
D) Excessive eating, constipation, and headache

Question 32

A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action?

A) Perform a thorough assessment of the patient.
B) Verify that security services are immediately available.
C) Self-assess personal attitude, values, and beliefs about this health problem.
D) Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

Question 33

What behaviours would the nurse expect to assess in a nontolerant drinker with a blood alcohol level of 0.20 mg%? Select all that apply.

A) Ataxia
B) Staggering
C) Confusion
D) Stupor
E) Emotional liability

Question 34

Which of the following would be part of the treatment plan for a person experiencing alcohol overdose? Select all that apply.

A) Monitor vital signs every 5 minutes
B) Monitor for respiratory depression
C) Maintain hydration with IV fluids
D) Administer antipsychotic medication
E) Administer oxygen

Question 35

A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. Which of the following does this scenario describe?

A) Cross-tolerance
B) Substance abuse
C) Substance addiction
D) Substance intoxication