Question 1

A patient comes to an outpatient appointment obviously intoxicated. The nurse should:

Accepted Answer

A)  explore the patient's reasons for drinking today. 
B)  arrange admission to an inpatient psychiatric unit. 
C)  coordinate emergency admission to a detoxification unit. 
D)  tell the patient, "We cannot see you today because you've been drinking."

Question 2

A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?

Accepted Answer

A)  Between 0800 and 1000 today (6 to 8 hours after drinking stopped) 
B)  Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped) 
C)  About 0200 on hospital day 3 (72 hours after drinking stopped) 
D)  About 0200 on hospital day 4 (96 hours after drinking stopped)

Question 3

A patient was admitted one day ago with a hip fracture sustained in a fall while intoxicated. The patient points to the Buck's traction and screams, "Somebody tied me up with ropes." The patient is experiencing:

Accepted Answer

A)  an illusion. 
B)  a delusion. 
C)  hallucinations. 
D)  hypnagogic phenomenon.

Question 4

A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?

Accepted Answer

A)  Monoamine oxidase inhibitor, such as phenelzine (Nardil) 
B)  Phenothiazine, such as thioridazine (Mellaril) 
C)  Benzodiazepine, such as lorazepam (Ativan) 
D)  Narcotic analgesic, such as morphine

Question 5

Which assessment findings will the nurse expect in an individual who has just injected heroin?

Accepted Answer

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

Question 6

In what significant ways is the therapeutic environment different for a patient who has ingested D-lysergic acid diethylamide (LSD) than for a patient who has ingested phencyclidine (PCP)?

Accepted Answer

A)  For LSD ingestion, one person stays with the patient and provides verbal support. For PCP ingestion, a regimen of limited contact with staff members is maintained, and continual visual monitoring is provided. 
B)  For PCP ingestion, the patient is placed on one-on-one intensive supervision. For LSD ingestion, a regimen of limited interaction and minimal verbal stimulation is maintained. 
C)  For LSD ingestion, continual moderate sensory stimulation is provided. For PCP ingestion, continual high-level stimulation is provided. 
D)  For LSD ingestion, the patient is placed in restraints. For PCP ingestion, seizure precautions are implemented.

Question 7

Which assessment findings best correlate to the withdrawal from central nervous system depressants?

Accepted Answer

A)  Dilated pupils, tachycardia, elevated blood pressure, elation 
B)  Labile mood, lack of coordination, fever, drowsiness 
C)  Nausea, vomiting, diaphoresis, anxiety, tremors 
D)  Excessive eating, constipation, headache

Question 8

A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?

Accepted Answer

A)  Check the patient every 15 minutes. 
B)  Rigorously encourage fluid intake. 
C)  Provide one-on-one supervision. 
D)  Keep the room dimly lit.

Question 9

A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, "Snakes are crawling on my bed. I've got to get out of here." What is the most accurate assessment of the 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 a recurrence of an acute psychosis.

Question 10

A newly hospitalized patient has needle tracks on both arms. A friend states that the patient uses heroin daily but has not used in the past 24 hours. The nurse should assess the patient for:

Accepted Answer

A)  slurred speech, excessive drowsiness, and bradycardia. 
B)  paranoid delusions, tactile hallucinations, and panic. 
C)  runny nose, yawning, insomnia, and chills. 
D)  anxiety, agitation, and aggression.

Question 11

When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After 1 year of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?

Accepted Answer

A)  Tolerance develops 
B)  The alcohol is less potent 
C)  Antagonistic effects occur 
D)  Hypomagnesemia develops

Question 12

A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is:

Accepted Answer

A)  jaundiced. 
B)  dependent on alcohol. 
C)  healthy but underweight. 
D)  microcephalic and cognitively impaired.

Question 13

An adult in the emergency department states, "I feel restless. Everything I look at wavers. Sometimes I'm outside my body looking at myself. I hear colors. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect a:

Accepted Answer

A)  cocaine overdose. 
B)  schizophrenic episode. 
C)  phencyclidine (PCP) intoxication. 
D)  D-lysergic acid diethylamide (LS
D)  ingestion.

Question 14

Which documentation indicates that the treatment plan for a patient in an alcohol treatment program was effective?

Accepted Answer

A)  Is abstinent for 10 days and states, "I can maintain sobriety one day at a time." Spoke with employer, who is willing to allow the patient to return to work in 3 weeks. 
B)  Is abstinent for 15 days and states, "My problems are under control." Plans to seek a new job where coworkers will not know history. 
C)  Attends AA daily; states many of the members are "real" alcoholics and says, "I may be able to help some of them find jobs at my company." 
D)  Is abstinent for 21 days and says, "I know I can't handle more than one or two drinks in a social setting."

Question 15

A patient asks for information about Alcoholics Anonymous (AA). Which is the nurse's best response?

Accepted Answer

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

Question 16

Which medication is the nurse most likely to see prescribed as part of the treatment plan for both a patient in an alcoholism treatment program and a patient in a program for the treatment of opioid addiction?

Accepted Answer

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

Question 17

A nurse can assist a patient diagnosed with addiction and the patient's family in which aspects of relapse prevention? (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)  Isolating self from significant others and social situations until sobriety is established 
E)  Teaching the patient about the physical changes to expect as the body adapts to functioning without substances

Question 18

A patient is admitted in a comatose state after ingesting five capsules of lorazepam. A friend of the patient says, "Often my friend drinks, along with taking more of the drug than is prescribed." What is the effect of the use of alcohol with this drug?

Accepted Answer

A)  The drug's metabolism is stimulated. 
B)  The drug's effect is diminished. 
C)  A synergistic effect occurs. 
D)  There is no effect.

Question 19

Select the nursing intervention necessary after administering naloxone (Narcan) to a patient experiencing an opiate overdose.

Accepted Answer

A)  Monitor the airway and vital signs every 15 minutes. 
B)  Insert a nasogastric tube and test gastric pH. 
C)  Treat hyperpyrexia with cooling measures. 
D)  Insert an indwelling urinary catheter.

Question 20

A patient with a history of daily alcohol use says, "Drinking helps me cope with being a single parent." Which response by the nurse would help the individual conceptualize the drinking more 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."

Exam 19: Substance-Related and Addictive Disorders