Deck 10: Substance Use Disorders

Question 1

A patient who smokes a pack of cigarettes daily develops tachycardia and irritability on the second day after abdominal surgery. What is the nurse's best action at this time?

A)Escort the patient outside where smoking is allowed.
B)Request a prescription for a nicotine replacement agent.
C)Tell the patient to calm down and not to think about smoking.
D)Ask the patient's family to bring in chewable tobacco products.

Answer 1

Request a prescription for a nicotine replacement agent.

Question 2

A patient presents to the emergency department with a blood alcohol concentration (BAC)of 0.18%. After reviewing the medication orders,which drug should the nurse administer first?

A)Oral multivitamin daily
B)Thiamine (vitamin B1) 100 mg daily
C)Lorazepam (Ativan) 1 mg as needed
D)Folic acid (Vitamin B9) 0.4 mg daily

Answer 2

Thiamine (vitamin B1) 100 mg daily

Question 3

A young adult patient scheduled for an annual physical examination arrives in the clinic smelling of cigarette smoke and carrying a pack of cigarettes. Which action will the nurse plan to take?

A)Urge the patient to quit smoking as soon as possible.
B)Avoid confronting the patient about smoking at this time.
C)Wait for the patient to start a discussion about quitting smoking.
D)Explain that the "cold turkey" method is most effective in stopping smoking.

Answer 3

Urge the patient to quit smoking as soon as possible.

Question 4

During physical assessment of a patient who has frequent nosebleeds,the nurse finds nasal sores and necrosis of the nasal septum. The nurse should ask the patient specifically about the use of which drug?

A)Heroin
B)Cocaine
C)Tobacco
D)Marijuana

Question 5

The nurse cares for an agitated patient who was admitted to the emergency department after taking a hallucinogenic drug and attempting to jump from a third-story window. Which nursing diagnosis should the nurse assign as the highest priority?

A)Risk for injury related to altered perception
B)Ineffective coping related to situational issues
C)Ineffective health maintenance related to drug use
D)Powerlessness related to loss of behavioral control

Question 6

Which assessment finding would alert the nurse to ask the patient about alcohol use?

A)Low blood pressure
B)Decreased heart rate
C)Elevated temperature
D)Abdominal tenderness

Question 7

Which information is most important for the nurse to report to the health care provider about a patient who has been using varenicline (Chantix)?

A)The patient continues to smoke a few cigarettes every day.
B)The patient complains of headaches that occur almost daily.
C)The patient complains of new-onset sadness and depression.
D)The patient says, "I have decided that I am not ready to quit."

Question 8

A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. What should the nurse do first?

A)Infuse normal saline.
B)Check oxygen saturation.
C)Draw blood for drug screening.
D)Obtain a 12-lead echocardiogram (ECG).

Question 9

A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated. The blood alcohol concentration (BAC)is 110 mg/dL (0.11 mg%). Which action by the nurse is appropriate?

A)Restrict oral and IV fluids.
B)Maintain the patient on NPO status.
C)Administer acetaminophen for headache.
D)Monitor for hyperreflexia and diaphoresis.

Question 10

The nurse plans postoperative care for a patient who smokes two packs of cigarettes daily. Which goal should the nurse include in the plan of care for this patient?

A)Improve sleep
B)Enhance appetite
C)Decrease diarrhea
D)Prevent sore throat

Question 11

A patient with alcohol dependence is admitted to the hospital with back pain following a fall. Twenty-four hours after admission,the patient becomes tremulous and anxious. Which action by the nurse is appropriate?

A)Encourage increased oral intake.
B)Insert an IV line and infuse fluids.
C)Provide a quiet, well-lit environment.
D)Administer opioids to provide sedation.

Question 12

An alcohol-intoxicated patient with a penetrating wound to the abdomen is undergoing emergency surgery. What will the nurse expect the patient to need during the perioperative period?

A)An increased dose of the general anesthetic medication
B)Interventions to prevent withdrawal symptoms within 2 hours
C)Frequent monitoring for bleeding and respiratory complications
D)Stimulation every hour to prevent prolonged postoperative sedation

Question 13

A newly admitted patient complains of waking frequently during the night. The nurse observes the patient wearing a nicotine patch on the right upper arm. Which action should the nurse take first?

A)Question the patient about use of the patch at night.
B)Suggest that the patient go to bed earlier in the evening.
C)Ask the health care provider about prescribing a sedative drug for nighttime use.
D)Remind the patient that the benefits of the patch outweigh the short-term insomnia.

Question 14

A patient with a history of heavy alcohol use is diagnosed with acute gastritis. Which statement by the patient indicates a willingness to stop alcohol use?

A)"I am older and wiser now, and I can change my drinking behavior."
B)"Alcohol has never bothered my stomach before.I think I have the flu."
C)"People say that I drink too much, but I feel pretty good most of the time."
D)"My drinking is affecting my stomach, but medication will help me feel better."

Question 15

A patient admitted with shortness of breath and chest pain who is a pack-a-day smoker tells the nurse,"I am just not ready to quit smoking yet." Which response by the nurse is appropriate for the patient's stage of change?

A)"This would be a really good time to quit."
B)"Your smoking is the cause of your chest pain."
C)"Are you familiar with nicotine replacement products?"
D)"What health problems do you think smoking has caused?"

Question 16

A 73-yr-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?

A)Mini-Mental State Examination
B)Drug Abuse Screening Test (DAST-10)
C)Screening Test-Geriatric Version (SMAST-G)
D)Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

Question 17

An older adult patient who has been taking alprazolam (Xanax)calls the clinic asking for a refill of the prescription 1 month before the alprazolam should need to be refilled. Which response by the nurse is best?

A)"The prescription cannot be refilled for another month.What happened to all of your pills?"
B)"Do you have muscle cramps and tremors if you don't take the medication frequently?"
C)"I will ask the health care provider to prescribe more pills, but you will not be able to have them until next month."
D)"I am concerned that you may be overusing those.Let's make an appointment for you with the health care provider."

Question 18

A 25-yr-old patient comes to the emergency department with severe chest pain and agitation. Which action should the nurse take first?

A)Ask about use of stimulant drugs.
B)Start an IV for sedative administration.
C)Assess orientation to person, place, and time.
D)Check blood pressure, pulse, and respirations.

Question 19

A disoriented and agitated patient comes to the emergency department and admits using methamphetamine. Vital signs are blood pressure 164/94 mm Hg,heart rate 136 beats/min and irregular,and respirations 32 breaths/min. Which action by the nurse is most important?

A)Reorient the patient at frequent intervals.
B)Monitor the patient's electrocardiogram (ECG).
C)Keep the patient in a quiet and darkened room.
D)Obtain a health history including prior drug use.

Question 20

A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze)illegally. What withdrawal signs does the nurse expect?

A)Tremors and seizures
B)Vomiting and diarrhea
C)Lethargy and disorientation
D)Delusions and hallucinations

Question 21

A patient who has a history of ongoing opioid use is hospitalized for surgery. After a visit by a friend,the nurse finds that the patient is unresponsive with pinpoint pupils. Which prescribed medication will the nurse administer?

A)Naloxone
B)Diazepam (Valium)
C)Clonidine (Catapres)
D)Methadone (Dolophine)

Question 22

A patient is admitted to the emergency department for treatment of a possible opioid overdose. Rank the nursing activities in the correct order from first activity to last activity. (Put a comma and a space between each answer choice [A,B,C,D,E]).

A)Initiate IV access.
B)Take a health history.
C)Administer naloxone
D)Obtain a toxicology screen
E)Provide respiratory support with a bag-valve mask.

Question 23

After the nurse receives report,which patient should the nurse assess first?

A)Patient who has a respiratory rate of 14 after overdosing on oxycodone (OxyContin)
B)Patient who is experiencing hallucinations and extreme anxiety after the use of marijuana
C)Patient with a history of daily alcohol use who is complaining of insomnia and diaphoresis
D)Patient admitted with cocaine use who has an irregular heart rate of 142 beats/minute and BP 186/92 mm Hg

Question 24

After receiving change-of-shift report on four patients who are undergoing substance use treatment,which patient will the nurse assess first?

A)A patient who has just arrived for alcohol use treatment and states that the last drink was 2 hours ago
B)A patient who is agitated and experiencing nausea, occasional vomiting, and diarrhea while withdrawing from heroin
C)A patient who has tremors secondary to benzodiazepine withdrawal and whose last benzodiazepine use was 4 days ago
D)A patient who is being treated for cocaine addiction and is irritable and disoriented, with a pulse rate of 112 beats/min

Question 25

Which nursing activity can the nurse delegate to unlicensed assistive personnel (UAP)who are working in a family practice clinic?

A)Make referrals to community substance use treatment centers.
B)Teach patients about the use of prescribed nicotine replacement products.
C)Obtain patient histories regarding alcohol, tobacco, and other substance use.
D)Administer and score the Alcohol Use Disorders Identification Test (AUDIT).