Deck 6: Nursing Care of Patients With Problems of Substance Abuse

Question 1

A patient tells the nurse that both of his parents are alcoholics and wonders about the likelihood of becoming an alcoholic as well. How should the nurse respond to the patient?

A) "There are studies that support a genetic link for developing alcoholism."
B) "Why are you concerned about becoming an alcoholic?"
C) "You will likely become an alcoholic."
D) "Don't worry about that."

Answer 1

"There are studies that support a genetic link for developing alcoholism."

Question 2

A nurse is concerned about potential substance abuse by a coworker. What behavior warrants further investigation?

A) The coworker frequently wastes medications.
B) The coworker frequently requests the largest patient care assignment for the shift.
C) The coworker prefers not to be the "medication nurse" on the shift.
D) The coworker declines to take scheduled breaks.

Answer 2

The coworker frequently wastes medications.

Question 3

The nurse manager is concerned that one staff nurse is demonstrating signs of substance abuse. Which behaviors did the manager observe in the staff nurse?

A) calling for days off or illness before scheduled days off
B) using the bathroom frequently
C) excessive use of mouthwash
D) volunteering to transfer a patient to the intensive care unit
E) following up with nursing assistants on patient care needs

Answer 3

calling for days off or illness before scheduled days off
using the bathroom frequently
excessive use of mouthwash

Question 4

A patient with a history of chronic alcohol use is underweight and malnourished. What should the nurse expect to be prescribed to manage the patient's nutritional status?

A) thiamine (vitamin B₁)
B) diazepam (Valium)
C) methadone
D) nalozone (Narcan)

Question 5

The nurse is concerned that a colleague is experiencing depression from substance abuse. What does the nurse observe to make this assumption?

A) The colleague leaves the unit and cannot be located for long periods of time.
B) The colleague uses the visitor bathroom instead of employee bathroom.
C) The colleague often eats lunch away from the hospital.
D) The colleague complains of frequent headaches at work.

Question 6

While analyzing data collected during an assessment, the nurse realizes that a patient's risk for alcohol abuse is low. What information did the nurse use to come to this conclusion?

A) The patient is Asian American.
B) The patient is diagnosed with type 2 diabetes.
C) The patient has two children.
D) The patient is employed as an accountant.

Question 7

A patient admitted with seizures is diagnosed with a perforated nasal septum. The nurse realizes that this patient most likely has abused which substance?

A) cocaine
B) marijuana
C) alcohol
D) barbiturates

Question 8

A patient is brought into the emergency department with a gunshot wound obtained while attempting to rob a convenience store. For which health problem should this patient be assessed?

A) drug and alcohol abuse
B) cardiovascular disease
C) respiratory disease
D) mental health disorder

Question 9

After a patient undergoes surgery, the nurse notes that the analgesics prescribed are not relieving the patient's pain. A review of the patient's medical records reveals a history of alcohol abuse. What inferences can the nurse make?

A) The patient is likely cross-tolerant to the prescribed analgesic.
B) The patient has an unreported addiction to the pain medication being prescribed.
C) The patient has a history of using this medication at home.
D) The patient has a dual diagnosis relating to alcohol and drug addiction.

Question 10

A patient comes into the emergency department wanting to be checked for sexual activity since she was out the other night at a rave and cannot remember what occurred. The nurse realizes that which addictive substance would cause this effect?

A) ecstasy
B) crank
C) marijuana
D) alcohol

Question 11

A teenage patient brought to the emergency department by his parents was reported to have taken barbiturates with alcohol. For which adverse effect should the nurse assess this patient?

A) respiratory depression
B) seizure activity
C) signs of withdrawal
D) signs of hallucinations

Question 12

A nurse consistently arrives to work wearing a long-sleeved blouse despite the temperature being in the 90s and the air humid. When colleagues mention her attire, the nurse becomes defensive and isolates herself from others. What does the nurse's behavior suggest?

A) substance abuse
B) a long-standing illness
C) introverted behavior
D) low self-esteem

Question 13

A patient is brought into the emergency department with dilated pupils, respiratory rate of six per minute, and seizure activity. What should the nurse prepare to administer to this patient?

A) nalozone (Narcan)
B) activated charcoal
C) ammonium chloride
D) diazepam (Valium)

Question 14

A patient tells the nurse that she started to have a glass of wine every evening at home after work to "unwind" and then realized that she cannot continue with her day unless she has the wine. The nurse realizes that this patient uses wine to

A) cope with day-to-day problems.
B) deal with difficulty expressing emotions.
C) suppress a genetic need for alcohol.
D) socialize with others.

Question 15

A patient recovering from outpatient carpal tunnel surgery returns to the surgical center the next day and tells the nurse that she is having trouble attending to daily activities and the pain is "excruciating," so she wants stronger pain medication immediately. What should this patient's behavior suggest to the nurse?

A) The patient could have a substance abuse problem.
B) A nerve was cut during the procedure.
C) The patient was not given strong enough postoperative pain medication.
D) The patient is under stress to return to work.

Question 16

A patient complaining of back pain tells the nurse that he needs several refills on any prescription since he takes the medication more frequently than prescribed. What should this information suggest to the nurse?

A) The patient has lost control over the consumption of the pain medication.
B) The patient is impulsive.
C) The patient uses the pain medication to fit in with a peer group.
D) The patient uses the pain medication to overcome low self-esteem.

Question 17

A patient comes to the emergency department with a PCP overdose. Which intervention should the nurse anticipate will be needed?

A) Administer haloperidol (Haldol) as prescribed
B) Induce vomiting
C) Talk the patient down
D) Administer nalozone (Narcan) as prescribed

Question 18

The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. What should the nurse suspect about the patient?

A) The patient's biological parents might have abused alcohol.
B) The patient spent time drinking with friends.
C) Consuming alcohol is a symptom of stress.
D) Alcoholism is a learned behavior.

Question 19

A patient tells the nurse that he becomes very angry and abusive to his friends and family when he is unable to obtain an illegal substance. How should the nurse respond to this patient?

A) "Have you considered seeking treatment for this behavior?"
B) "You must not have many friends left."
C) "Are you this argumentative when at work?"
D) "What does your family say about this?"

Question 20

A patient involved in a minor accident reports having used "crank" an hour ago. The patient denies having used the drug before. What manifestations can the nurse anticipate occurring with this patient?

A) reports feelings of insomnia and confusion
B) shows increased strength and cognition
C) displays paranoia
D) exhibits hallucinations

Question 21

A nurse is concerned that a newly hired colleague is exhibiting signs of a substance abuse problem. What did the nurse observe to come to this conclusion?

A) The new nurse is always sucking on mints and has applied strong-smelling cologne.
B) The new nurse completes documentation and is prepared to give report at the end of the shift.
C) The new nurse has volunteered to give medications to patients.
D) The new nurse has displayed difficulty juggling his patient assignment and seems to be highly unorganized.
E) The narcotic count at the end of the shift is off; two doses of morphine sulfate are missing.

Question 22

The patient states she has been using an illegal drug for the last nine years. Based on the information included in the chart, which statement is most consistent with the type of illegal drug she has been abusing?

A) "My husband and I smoke our fair share of herb."
B) "I should tell you tell that I drink quite a bit of hooch."
C) "I am probably addicted to Big D ."
D) "I use the white stuff."

Question 23

The patient has consumed 660 milligrams of caffeine during the last eight hours. The patient states that he consumes this amount of caffeine on a regular basis. After reviewing the information included in the chart provided, which patient statement is consistent with the information provided?

A) "I don't know why but I just can't get to sleep."
B) "I always feel cold."
C) "I have been so constipated."
D) "I have no appetite."

Question 24

A patient has overdosed on benzodiazepines and is admitted in a comatose state. What is the best order for treatment?

A) Clear airway
B) Prepare to intubate
C) Prepare for IV fluids
D) Prepare for gastric lavage
E) Institute seizure precautions
F) Prepare for possible dialysis
G) non of the above.

Question 25

The nurse is caring for a patient with chronic alcoholism. Which vitamins should the nurse expect this patient to be prescribed?

A) thiamine (vitamin B₁)
B) folic acid
C) cyanocobalamin (vitamin B₁₂)
D) vitamin E
E) potassium chloride

Question 26

The patient has been brought to the emergency department after being found by his mother at home. The patient's blood alcohol level is currently 0.51%. Which findings are consistent with this information?

A) A sternal rub was performed with no response elicited.
B) The patient's respiratory rate is eight breaths per minute.
C) The patient's radial and pedal pulses are bounding.
D) The patient states, "I sleep for a long time, but I never feel rested when I wake up."
E) The patient states, "I really think I can drive myself home. I am fine!"

Question 27

The nurse is beginning the assessment of a patient with substance abuse. What should the nurse ask that demonstrates an open-ended question?

A) On average, how many days a week do you drink or use drugs?
B) How often and how much do you usually use?
C) What is the greatest number of drinks you have had at any one time in the past month?
D) Do you drink beer or whiskey?
E) Did you drink beer before coming to the hospital?

Question 28

A patient withdrawing from alcohol has an order for diazepam (Valium), 10 mg every 4 hours for 4 doses, then 5 mg every 4 hours for 4 doses. The drug comes in a concentration of 5 mg/mL. The total mL that the patient will receive would be _____.

Question 29

The nurse is reviewing the way abusive substances act on brain receptor sites. Place an "X" on the picture that represents an antagonistic effect.

Question 30

The nurse is preparing material for a staff development presentation on substance abuse. Which information should the nurse include that addresses the family history of substance abuse?

A) There is a genetic link between having an alcoholic parent and developing problems related to substance use.
B) These genetic issues are more often related to alcohol, marijuana, and tobacco use.
C) One type of genetically related alcoholism is associated with an antisocial personality disorder, early use, and an inability to stop drinking.
D) The patient has an increased likelihood of developing substance use problems when the mother of the patient is an alcoholic rather than the father.
E) Some studies indicate that adolescents who are more genetically prone to develop alcoholism were less likely to have other types of substance use problems.

Question 31

A patient admitted to the hospital after a motor vehicle accident frequently smokes ice and had smoked some as recently as two hours prior to the accident. Which assessment findings are consistent with this information?

A) Apical heart rate is 112 beats per minute.
B) Preventricular contractions are noted during electrocardiogram.
C) The patient weighs 92 pounds and is 5'5" tall.
D) The patient is complaining of chest pain.
E) Blood pressure is 96/72.

Question 32

The patient states, "I think I am actually addicted to nicotine." Which assessment findings are consistent with this type of addiction?

A) The blood pressure is 182/86.
B) The patient states, "Sometimes, I feel so nauseated after I smoke cigarettes."
C) The patient states, "I have never been able to stop smoking for more than two weeks at a time because the cravings get so bad."
D) An apical heart rate is 72 beats per minute.
E) A respiratory rate is 14 breaths per minute.

Question 33

The nurse suspects that a patient has a substance dependency. What observations did the nurse use to come to this conclusion?

A) presence of tolerance
B) substance taken longer than intended
C) spends more time in private using the substance
D) desire to control substance use
E) discontinues use while experiencing intrapersonal problems

Question 34

The nurse is caring for a patient who uses marijuana. Which observations suggest that the amount of marijuana that the patient is using is dose-related?

A) fetal CNS disturbances
B) tachycardia
C) asthma with long-term use
D) diuresis
E) hypertension

Question 35

The nurse reviews the long-term effects of alcohol use with a patient who has experienced chronic alcoholism for 25 years. Which patient statements indicate that addition teaching is required?

A) "My yellow skin is really just caused by the thiamine deficiency."
B) "My problems with COPD weren't because I smoke; it's because I was drinking so much."
C) "I was surprised to learn that my coronary artery disease may have been worsened by my drinking."
D) "I think I would've stopped drinking a long time ago if I had known that it may have caused my impotence."
E) "My mom was an alcoholic and died from breast cancer and it may have been the result of her drinking."

Question 36

A loading dose of magnesium sulfate 4g is ordered for a patient. The concentration available is 4g/250 mL to be given over 30 minutes. How many mL/hr should the nurse set the patient's infusion pump to deliver the medication?

Question 37

The patient has been included in a research study along with 4,205 other patients who live in the United States. Two thousand two hundred of these patients are male. Of the female patients, how many are likely to be smokers?

Question 38

The patient is exhibiting some addictive behaviors and has admitted to using illegal drugs. Which patient statements are consistent with addictive behaviors?

A) "I think even as a child I was much more anxious than my friends."
B) "When I was in the hospital for appendicitis, they told me they had to give me more pain medications than normal because I was still in pain."
C) "Sometimes I steal things from stores just to see if I can get away with it."
D) "I like to play it safe. When my friends were bungee jumping off the bridge, I just watched."
E) "I have always been very slow to anger."

Question 39

The patient has been diagnosed with substance dependence. The patient has been using Bennies for the last three years. Which patient statements should the nurse attribute to substance dependence?

A) "I am so tired and I feel so down about everything that is happening around me."
B) "I really tried to cut down my use, but I fail miserably every time."
C) "The only thing I care about right now is getting my fix."
D) "I have to use a lot more right now to get the same high as I did before."
E) "I have a great job where I work fulltime as a mechanical engineer, so that part of my life is very fulfilling."

Question 40

A patient admitted to an addiction detoxification unit has been prescribed medication to help with withdrawal symptoms. After reviewing the medication with the patient, the nurse realizes that further education is required when the patient makes which statements?

A) "Naltrexone is an antidepressant."
B) "The Antabuse will help me with my cravings for heroin."
C) "The clordiazepoxide is also called Librium and it can help with my anxiety."
D) "The phenobarbital will help prevent me from having another seizure."
E) "I need folic acid and other vitamin supplements because I haven't eaten well for so long."

Question 41

A nurse has been convicted of driving while under the influence. What regulatory body will determine the status of the nurse's license?

A) state board of nursing
B) employee assistance program
C) state court system
D) American Nurses Association

Question 42

The nurse is determining a patient's degree of dependence on a substance. Which screening tools should the nurse use to help with this assessment?

A) Michigan Alcohol Screening Test
B) CAGE questionnaire
C) Brief Drug Abuse Screening Test
D) Clinical Institute Withdrawal Assessment of Alcohol-Revised
E) Clinical Opiate Withdrawal Scale

Question 43

The nurse identifies the problem of imbalanced nutrition due to insufficient intake for a patient hospitalized for substance abuse. What interventions should the nurse identify as appropriate for this patient?

A) Monitor the CBC and liver enzymes
B) Collaborate with the dietician
C) Administer vitamins and diet supplements
D) Provide high fat, high carbohydrate diet
E) Restrict fluid intake to 1500 mL per day

Question 44

During an assessment a patient with multiple substance addictions asks why the need for drugs and alcohol is so great. What should the nurse include when responding to this patient?

A) "Substance abuse is sign of weakness and boredom with life."
B) "Alcohol reinforces the transmission of opioids in the system."
C) "There is a human tendency to seek pleasure and avoid stress and pain."
D) "It really depends upon genetic makeup and if your parents used drugs."
E) "One substance in the brain, dopamine, is responsible for drug-seeking behavior."

Question 45

The nurse is assessing a patient for alcohol abuse. On which mental health problems should the nurse focus during this assessment?

A) psychosis
B) depression
C) malnutrition
D) Alzheimer disease
E) cerebrovascular accident

Question 46

The nurse decides to include the CAGE questionnaire and B-DAST screening tool when assessing an adolescent admitted with panic and agitation. For which substances is this nurse most likely planning to assess in this patient?

A) PCP
B) LSD
C) crack
D) heroin
E) alcohol

Question 47

The nurse manager suspects that a nurse is experiencing role strain and is at risk for developing substance abuse. What did the manager observe to come to this conclusion about the nurse?

A) frequently late to work
B) incomplete charting
C) errors in patient care judgment
D) erratic behavior
E) mood swings

Question 48

The nurse is concerned that a patient being seen in the mental health clinic for psychosis is at risk for substance abuse. What assessment findings support this nurse's concern?

A) age 19
B) male gender
C) younger siblings in high school
D) mother in rehabilitation for heroin
E) recently terminated from employer