Question 1

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?

Accepted Answer

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 behavior carefully."
D)   "It is good that you are supportive of your spouse's sobriety and want to help maintain it." A

Question 2

A patient took a large quantity of bath salts.Priority nursing and medical measures include: (select all that apply)

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. D,E

Question 3

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 striving for abstinence one day at a time."
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." B

Question 4

The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply)

Accepted Answer

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 5

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

Accepted Answer

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

Question 6

A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse)therapy.Patient teaching should include the need to: (select all that apply)

Accepted Answer

A)   avoid aged cheeses.
B)   avoid alcohol-based skin products.
C)   read labels of all liquid medications.
D)   wear sunscreen and avoid bright sunlight.
E)   maintain an adequate dietary intake of sodium. F)  avoid breathing fumes of paints, stains, and stripping compounds.

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?

Accepted Answer

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

Question 8

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

Accepted Answer

A)   Bromocriptine (Parlodel) 
B)   Methadone (Dolophine) 
C)   Disulfiram (Antabuse) 
D)   Naltrexone (ReVia)

Question 9

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?

Accepted Answer

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 10

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 colorful
D)   Confrontational and challenging

Question 11

A new patient beginning an alcoholism rehabilitation program says,"I'm just a social drinker.I usually have one drink at lunch,two in the afternoon,wine at dinner,and a few drinks during the evening." Select the nurse's most therapeutic responses.Select all that apply.

Accepted Answer

A)   "I see," and use interested silence.
B)   "I think you are drinking more than you report."
C)   "Social drinkers have one or two drinks, once or twice a week."
D)   "You describe drinking steadily throughout the day and evening."
E)   "Your comments show denial of the seriousness of your problem."

Question 12

Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year.Prior to discharge,the patient will:

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 13

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 center 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 14

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 15

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours.The patient is now shaky,irritable,anxious,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.The patient:

Accepted Answer

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

Question 16

Police bring a patient to the emergency department after an automobile accident.The patient demonstrates ataxia and slurred speech.The blood alcohol level is 500 mg%.Considering the relationship between the behavior and blood alcohol level,which conclusion is most probable? The patient:

Accepted Answer

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

Question 17

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 defense mechanism?

Accepted Answer

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

Question 18

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: $\quad$118/78 mm Hg and 72 beats/min
0400: $\quad$126/80 mm Hg and 76 beats/min
0600: $\quad$128/82 mm Hg and 72 beats/min
0800: $\quad$132/88 mm Hg and 80 beats/min
1000: $\quad$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 19

A patient is thin,tense,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?

Accepted Answer

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

Question 20

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

Accepted Answer

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 behavior."

Exam 22: Substance Related and Addictive Disorders