Deck 14: Substance Use and Addictive Disorders

Question 1

A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions?

A) Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance.
B) Sedative-hypnotics are expensive and have numerous side effects.
C) Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep.
D) Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

Answer 1

Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance.

Question 2

A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching?

A) After discharge, the client will immediately attend 90 AA meetings in 90 days.
B) After discharge, the client will rely on an AA sponsor to help control alcohol cravings.
C) After discharge, the client will incorporate family in AA attendance.
D) After discharge, the client will seek appropriate deterrent medications through AA.

Answer 2

After discharge, the client will immediately attend 90 AA meetings in 90 days.

Question 3

On the first day of a client's alcohol detoxification, which nursing intervention should take priority?

A) Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days.
B) Educate the client about the biopsychosocial consequences of alcohol abuse.
C) Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.
D) Administer vitamin B₁ to prevent Wernicke-Korsakoff syndrome.

Answer 3

Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.

Question 4

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed?

A) "A diet rich in protein will promote hepatic healing."
B) "This condition results from a rise in serum ammonia, leading to impaired mental functioning."
C) "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity."
D) "Neomycin and lactulose are used in the treatment of this condition."
E) "This condition is caused by the inability of the liver to convert ammonia to urea."

Question 5

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority?

A) Hearing and visual impairment
B) Blood pressure of 180/100 mm Hg
C) Mood rating of 2/10 on numeric scale
D) Dehydration

Question 6

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction?

A) Narcotic pain medication is contraindicated for all clients with active substance use disorders.
B) Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.
C) There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance.
D) The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

Question 7

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur?

A) 50 mg/dL
B) 100 mg/dL
C) 250 mg/dL
D) 300 mg/dL

Question 8

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?

A) Risk for injury R/T central nervous system stimulation
B) Disturbed thought processes R/T tactile hallucinations
C) Ineffective coping R/T powerlessness over alcohol use
D) Ineffective denial R/T continued alcohol use despite negative consequences

Question 9

A client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." A nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97 $\degree$ F (36 $\degree$ C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis?

A) Knowledge deficit
B) Fluid volume excess
C) Imbalanced nutrition: less than body requirements
D) Ineffective individual coping

Question 10

Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine-withdrawal delirium?

A) Haloperidol (Haldol) and fluoxetine (Prozac)
B) Carbamazepine (Tegretol) and donepezil (Aricept)
C) Disulfiram (Antabuse) and lorazepan (Ativan)
D) Chlordiazepoxide (Librium) and phenytoin (Dilantin)

Question 11

Which client statement demonstrates positive progress toward recovery from a substance use disorder?

A) "I have completed detox and therefore am in control of my drug use."
B) "I will faithfully attend Narcotic Anonymous when I can't control my cravings."
C) "As a church deacon, my focus will now be on spiritual renewal."
D) "Taking those pills got out of control. It cost me my job, marriage, and children."

Question 12

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response?

A) "Why do you assume responsibility for his behaviors?"
B) "I think you should start to confront his behavior."
C) "Your husband needs to deal with the consequences of his drinking."
D) "Do you understand what the term enabler means?"

Question 13

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation?

A) Psychological addiction
B) Codependence
C) Substance induced disorder
D) Social induced disorder

Question 14

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention?

A) To assess for emotional strength
B) To assess for Wernicke-Korsakoff syndrome
C) To assess for tachycardia
D) To assess for fine tremors

Question 15

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler?

A) Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not.
B) Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men.
C) Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course.
D) Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

Question 16

A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed?

A) "The state board of nursing must be notified with factual documentation of impairment."
B) "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice."
C) "Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work."
D) "After a return to practice, a recovering nurse may be closely monitored for several years."

Question 17

Which client statement indicates a knowledge deficit related to a substance use disorder?

A) "Although it's legal, alcohol is one of the most widely abused drugs in our society."
B) "Tolerance to heroin develops quickly."
C) "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously."
D) "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

Question 18

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the client's physician to treat this disorder. The nurse would give the client information on which medications?

A) Escitalopram (Lexapro) and clozapine (Clozaril)
B) Citalopram (Celexa) and olanzapine (Zyprexa)
C) Lithium carbonate (Lithobid) and sertraline (Zoloft)
D) Naltrexone (ReVia) and ziprasidone (Geodon)

Question 19

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal?

A) Antagonist therapy
B) Deterrent therapy
C) Codependency therapy
D) Substitution therapy

Question 20

Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder?

A) "I am easily manipulated and need to work on this prior to caring for these clients."
B) "Because of my father's alcoholism, I need to examine my attitude toward these clients."
C) "I need to review the side effects of the medications used in the withdrawal process."
D) "I'll need to set boundaries to maintain a therapeutic relationship."
E) "I need to take charge when dealing with clients diagnosed with substance disorders."

Question 21

A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include?

A) A hotline number will be available in order to call for peer assistance.
B) A verbal contract detailing the method of treatment will be initiated prior to the program.
C) Peer support is provided through regular contact with the impaired nurse.
D) Contact to provide peer support will last for one year.
E) One of the program goals is to intervene early in order to reduce hazards to clients.

Question 22

Order the following stages of the codependency recovery process according to Cermak.
________ The Core Issues Stage
________ The Reintegration Stage
________ The Survival Stage
________ The Reidentification Stage

Question 23

A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired?

A) The staff nurse is frequently absent from work.
B) The staff nurse experiences mood swings.
C) The staff nurse makes elaborate excuses for behavior.
D) The staff nurse frequently uses the restroom.
E) The staff nurse has a flushed face.

Question 24

The concept of _______________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

Question 25

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess?

A) Stressful situations precipitate gambling behaviors.
B) Anxiety and restlessness can only be relieved by placing a bet.
C) Winning brings about feelings of sexual satisfaction.
D) Gambling is used as a coping strategy.
E) Losing at gambling meets the client's need for self-punishment.

Question 26

A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior?

A) The client has a long history of focusing thoughts and behaviors on other people.
B) The client, as a child, experienced overindulgent and overprotective parents.
C) The client is a people pleaser and does almost anything to gain approval.
D) The client exhibits helpless behaviors but actually feels very competent.
E) The client can achieve a sense of control only through fulfilling the needs of others.
Other