Question 1

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.

Accepted Answer

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. C

Question 2

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?

Accepted Answer

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

Question 3

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?

Accepted Answer

A)   Disturbed sensory perception
B)   Ineffective coping
C)   Ineffective denial
D)   Risk for injury D

Question 4

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

Accepted Answer

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

Question 5

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?

Accepted Answer

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."

Question 6

Which of the following would be part of the treatment plan for a person experiencing alcohol overdose?

Accepted Answer

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 7

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?

Accepted Answer

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 8

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 and76 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?

Accepted Answer

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 9

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

Accepted Answer

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

Question 10

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?

Accepted Answer

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

Question 11

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

Accepted Answer

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 12

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?

Accepted Answer

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 13

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?

Accepted Answer

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

Question 14

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

Accepted Answer

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

Question 15

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?

Accepted Answer

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

Question 16

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

Accepted Answer

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

Question 17

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.

Accepted Answer

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.

Question 18

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

Accepted Answer

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

Question 19

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?

Accepted Answer

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 20

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

Accepted Answer

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."

Exam 18: Psychoactive Substance Use and Treatment