Question 1

A hospitalized patient diagnosed with alcohol use 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 2

A patient asks for information about AA. Select the nurse's best response. "AA is a

Accepted Answer

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

Question 3

In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/minute; respirations 8 breaths/minute and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to opioid 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/minute, and respirations at or above 12 breaths/minute. 
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 4

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

Accepted Answer

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

Question 5

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should

Accepted Answer

A)  provide long-term care for the patient in a residential facility. 
B)  withdraw the patient from cannabis, then treat the schizophrenia. 
C)  consider each diagnosis primary and provide simultaneous treatment. 
D)  first treat the schizophrenia, then establish goals for substance abuse treatment.

Question 6

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/minute. 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 7

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."

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 
B)  Methadone 
C)  Disulfiram 
D)  Naltrexone

Question 9

Symptoms of withdrawal from opioids for which the nurse should assess include

Accepted Answer

A)  dilated pupils, tachycardia, elevated blood pressure, and elation. 
B)  nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. 
C)  mood lability, incoordination, fever, and drowsiness. 
D)  excessive eating, constipation, and headache.

Question 10

After discovering discrepancies and missing controlled substances, the nursing supervisor determines that a valued, experienced staff nurse is responsible. Which actions should the nursing supervisor take? (Select all that apply.)

Accepted Answer

A)  Refer the nurse to a peer assistance program. 
B)  Confront the nurse in the presence of a witness. 
C)  Immediately terminate the nurse's employment. 
D)  Relieve the nurse of responsibilities for patient care. 
E)  Require the nurse to undergo immediate drug testing.

Question 11

Which goal for treatment of alcohol use disorder 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 physiological stability.

Question 12

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. The nurse should suspect

Accepted Answer

A)  a schizophrenic episode. 
B)  hallucinogen ingestion. 
C)  opium intoxication. 
D)  cocaine overdose.

Question 13

A patient admitted yesterday for injuries sustained while intoxicated believes insects 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 14

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates poor coordination and slurred speech but the vital signs are normal. The blood alcohol level is 300 mg/dL (0.30 g/dL). Considering the relationship between the assessment findings 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 15

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/minute
0400: 126/80 mm Hg and 76 beats/minute
0600: 128/82 mm Hg and 72 beats/minute
0800: 132/88 mm Hg and 80 beats/minute
1000: 148/94 mm Hg and 96 beats/minute
What is the nurse's priority action?

Accepted Answer

A)  Force fluids. 
B)  Begin the detox protocol. 
C)  Obtain a clean-catch urine sample. 
D)  Place the patient in a vest-type restraint.

Exam 22: Substance-Related and Addictive Disorders