56: Chapter Substance-Related Disorders
MULTIPLE CHOICE 1. A patient has been diagnosed with alcoholism. The nurse tells him that he has a physical illness with a genetic predisposition to alcoholism and the only effective treatment is total abstinence from alcohol. This type of approach characterizes: 1. biologic theory. 2. behavioral theory. 3. sociocultural theory. 4. intrapersonal theory. ANS: 1 This question requires the test taker to differentiate among the theories and approaches commonly used with patients who are addicted. PTS: 1 DIF: Cognitive Level: Comprehension REF: 1265 OBJ: 1 TOP: Etiology and Risk Factors KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity 2. The nurse explains that according to the intrapersonal theory, addiction is caused by early childhood rejection. These substance abusers are thought to have common characteristics that include: 1. an open boundary approach to life that likes to party frequently. 2. attention seeking, need for control, and self-centeredness. 3. shyness and anxiety. 4. stress and eagerness to be a part of the in group. ANS: 2 The intrapersonal theory identifies the common personality traits of self-centeredness, need for control, and attention seeking as parts of the addictive personality. PTS: 1 DIF: Cognitive Level: Analysis REF: 1265 OBJ: 1 TOP: Etiology and Risk Factors KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 3. To assess the amount of pain medication needed by the patient who has bone cancer, but who has also been using heroin, the best approach is to: 1. tell the patient that getting his pain under control will be difficult because he uses heroin. 2. ask the pharmacist to help you compute the amount of pain medication that you think he will need. 3. try to use nonopioid medications so that you do not interfere with his heroin needs. 4. openly question the patient about his daily heroin use. ANS: 4 When trying to get a health history on a substance abuse patient, the best method is an open discussion of the drug use. The discussion should be open and nonjudgmental.
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Synthesis REF: 1267 2 TOP: Nursing Assessment of the Substance Abuser Nursing Process Step: Implementation NCLEX: Physiological Integrity
4. An alcoholic patient is brought to the inpatient psychiatric unit saying that he does not know where he is or what day it is. Because he has a heavy drinking history, you suspect that he is having: 1. delirium. 2. alcoholic dementia. 3. blackout. 4. amnesia. ANS: 3 Blackouts are common with heavy drinking over time. The patient data support that the memory loss is associated with the alcohol use, and blackouts would be an expected outcome. PTS: 1 DIF: Cognitive Level: Analysis REF: 1267 OBJ: 2 TOP: Patterns and Consequences of Abuse KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 5. The nurse is discharging a pulmonary patient home with her family. She has had a difficult time while in the hospital and experienced withdrawal from tobacco. When the nurse tells her that there are community resources to help her to stop smoking, she says, Thats OK; I can stop whenever I want to. This is an example of: 1. rationalization. 2. denial. 3. intellectualization. 4. projection. ANS: 2 Denial is a common defense mechanism used by substance abusers. PTS: 1 DIF: Cognitive Level: Application REF: 1267 OBJ: 3 TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 6. A patient with an alcohol addiction says, My drinking is all my wifes fault. She makes me so crazy I just have to have a drink. This is an example of: 1. rationalization. 2. denial. 3. intellectualization. 4. projection. ANS: 4 The patient in the scenario is projecting. He is blaming his wife for his drinking problem rather than accepting that the drinking is his problem. PTS: 1 DIF: Cognitive Level: Application REF: 1267
OBJ: 3 TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 7. Substance abuse might be suspected in a patient who has: 1. abnormal liver function tests and a GI bleed. 2. a positive syphilis screen and varicose veins. 3. a fungal infection and a potassium level of 4.2. mEq/L. 4. a decreased albumin level and creatinine level of 1.2 mg/dL. ANS: 1 Abnormal liver function tests and a GI bleed indicate substance abuse. PTS: 1 DIF: Cognitive Level: Application REF: 1268 OBJ: 2 TOP: Diagnostic Tests KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 8. A urine drug screen is ordered for a patient suspected of a DWI. The nurse explains that drugs that are being screened for can include: 1. lysergic acid diethylamide (LSD), Valium, and Percocet. 2. crack, heroin, and nonsteroidal anti-inflammatory drugs (NSAIDs). 3. marijuana, amphetamines, and Elavil. 4. Librium, cocaine, and Zoloft. ANS: 1 Option 1 has the correct combination of an illicit drug, an anxiolytic, and an opioid. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 2 TOP: Urine Drug Screening Nursing Process Step: Implementation NCLEX: Physiological Integrity REF: 1268
9. When an alcoholic patient brought in 12 hours ago in an intoxicated state begins to exhibit tremors and increased blood pressure and is agitated, the nurse assesses that the patient is in: 1. major withdrawal. 2. early withdrawal. 3. delirium tremens. 4. minor withdrawal. ANS: 2 The signs of early withdrawal from alcohol are agitation and elevated vital signs. These warning signs usually occur 6 to 12 hours after the last drink. PTS: 1 DIF: Cognitive Level: Application REF: 1269 OBJ: 3 TOP: Alcoholism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 10. The nurse is aware that the alcoholic patient is at risk for a syndrome related to thiamine deficiency, which is: 1. fetal alcohol syndrome. 2. Wernickes encephalopathy.
3. Korsakoffs psychosis. 4. alcoholic dementia. ANS: 2 Wernickes encephalopathy is a vitamin B1 (thiamine) deficiency. If not treated with vitamin supplements, the condition can progress to a more serious form. PTS: 1 DIF: Cognitive Level: Application REF: 1269 OBJ: 3 TOP: Medical Complications KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity 11. The wife of a long-term alcoholic wants to help her husband quit drinking. The nurse tells her that an initial approach might be for a group of friends and family to confront the patient with his alcoholism and tell him that: 1. he needs help; his drinking is out of hand. 2. they are fed up with him and will no longer be his friend. 3. they reject his drinking but think he is a valuable person. 4. he is still their friend, even if he doesnt stop drinking. ANS: 3 The implementation for encouraging an alcoholic to go into treatment consists of a group of people telling the alcoholic that they think his drinking is destructive but they do not reject him as a person. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 3 TOP: Implementation Nursing Process Step: Implementation NCLEX: Psychosocial Integrity REF: 1270
12. The nurse recommends to an alcoholic that he join Alcoholics Anonymous because this organization is: 1. based on a 12-step approach with a strong religious base. 2. a social group of ex-drinkers who befriend the alcoholic in the process of maintaining sobriety. 3. a religious support group that assists alcoholics during rehabilitation. 4. an anonymous group of sponsors who offer help to alcoholics. ANS: 1 Alcoholics Anonymous is a group of people who come together to offer support to each other to stay sober. It has a religious base, recognizes a higher power, and uses a 12-step approach to sobriety. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis 3 TOP: Rehabilitation Nursing Process Step: Implementation NCLEX: Psychological Integrity REF: 1270
13. The nurse cautions a patient who is taking disulfiram (Antabuse) that ____ should be avoided. 1. Aged cheese
2. Pickled foods 3. Mouthwash 4. Chocolate candy ANS: 3 Mouthwash contains alcohol and can trigger the effect of an Antabuse reaction. The alcoholic taking Antabuse needs to be aware of the hidden alcohol in some commonly used mouthwashes and other over-the-counter drugs. PTS: 1 DIF: Cognitive Level: Application REF: 1274 OBJ: 3 TOP: Medications KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 14. The nurse on the admission unit is informed that a patient is being brought in who has been using ice. The nurse is aware that this patient may be: 1. extremely dehydrated. 2. in a coma. 3. dangerously hypertensive. 4. violent. ANS: 4 Persons who use ice, a form of methamphetamine, are frequently violent while under the influence. The effect of ice can last as long as 12 to 14 hours. PTS: 1 DIF: Cognitive Level: Application REF: 1274 OBJ: 4 TOP: Stimulants KEY: Nursing Process Step: N/A MSC: NCLEX: Integrity Physiological 15. In assisting with the development of a nursing care plan for a patient who has been using cocaine for 5 years, the nurse will include provisions to deal with: 1. depression. 2. violent behavior. 3. nasal erosion. 4. suicidal attempt. ANS: 1 Cocaine users can be depressed for as long as 2 years after quitting drug use. An antidepressant such as bupropion (Wellbutrin) is helpful in treating the depression. PTS: 1 DIF: Cognitive Level: Application REF: 1274 OBJ: 7 TOP: Cocaine KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 16. Marijuana is a hallucinogenic that can be used for positive effects in the treatment of: 1. diet control in the morbidly obese. 2. chemotherapy-induced nausea and vomiting. 3. air hunger in end-stage emphysema patients 4. early diabetic-induced cataracts. ANS: 2
Marijuana has been studied for use for nausea and vomiting in cancer patients. Marinol (dronabinol) is a marijuana derivative currently available for use with cancer patients. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 4 TOP: Hallucinogens Nursing Process Step: Implementation NCLEX: Physiological Integrity REF: 1275
17. The nurse counsels a pregnant cocaine abuser that her cocaine use put the baby at risk for: 1. severe allergies. 2. neurologic impairments. 3. hearing impairment. 4. higher birth weights. ANS: 2 Babies born to mothers of cocaine addicts have a higher incidence of hyperactivity and neurologic problems. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Analysis REF: 1277 8 TOP: Disorders Associated with Cocaine Use Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance
18. Sometimes methadone is used in the treatment of heroin addiction. One reason that methadone is substituted for heroin is: 1. it is a way to substitute one opioid for another. 2. it is less constipating than heroin. 3. methadone does not give the rush that heroin addicts are looking for. 4. it is a synthetic opioid, which makes it less addicting. ANS: 3 Methadone as an extended-release medication does not give the rush that addicts enjoy. It maintains the opioid level in the body but does so at a steady state and decreases cravings. PTS: 1 DIF: Cognitive Level: Application REF: 1270 OBJ: 4 TOP: Medications KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity 19. Narcan has been given to the heroin addict with respiratory depression. The nurse is alert for indications of: 1. acute withdrawal symptoms. 2. respiratory arrest. 3. hypotensive crisis. 4. cardiac arrest. ANS: 1 Narcan is an opioid antagonist that causes the opioid to fall from receptor sites. When antagonist is given, the sudden loss of the opioid causes acute withdrawal to occur. PTS: 1 DIF: Cognitive Level: Analysis REF: 1279
OBJ: 4 TOP: MedicationsNarcan KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 20. The treatment plans for alcohol abusers and drug abusers are similar90 meetings in 90 days and 12-step programs. One difference is that: 1. one program uses a 12-step approach and the other has a religious base. 2. heroin addicts have a higher success rate. 3. alcohol abusers have an easier time staying with the program. 4. relapse rates for patients using drugs other than alcohol alone are much higher. ANS: 4 One difference between alcohol and drug rehabilitation programs is that drug abusers will have a lower success rate. Alcohol abusers will have a higher rate of success when they follow the Alcoholics Anonymous program. PTS: 1 DIF: Cognitive Level: Analysis REF: 1279-1280 OBJ: 6 TOP: Rehabilitation KEY: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity 21. A nursing diagnosis that is appropriate for a patient with substance abuse is: 1. Anxiety. 2. Chronic or situational low self-esteem. 3. Risk for delayed development. 4. Acute confusion. ANS: 2 Low self-esteem is related to loss of control and guilt. PTS: 1 DIF: Cognitive Level: Application REF: 1280 OBJ: 7 TOP: Nursing DiagnosisSubstance Abuse KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 22. An implementation that can be used to help prevent relapse in a patient who has a substance abuse problem is: 1. self-hypnosis. 2. imagery. 3. stress management. 4. blocking. ANS: 3 Teaching these patients stress management will assist them in managing the conflict and stress in their daily lives that previously triggered substance abuse. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 7 TOP: Implementations Nursing Process Step: Implementation NCLEX: Psychosocial Integrity REF: 1281
23. Older patients have a separate set of issues that affect their use of alcohol and other drugs. Some of these issues are all of the following except:
1. 2. 3. 4.
a higher rate of alcoholism in retirement communities. peer pressure to drink more at social occasions. using alcohol to relieve the stress of aging. drinking to cope with social isolation.
ANS: 1 There is a higher rate of alcoholism in retirement communities because older adults are encouraged to drink at dinner and special occasions. PTS: 1 DIF: Cognitive Level: Application REF: 1282 OBJ: 8 TOP: Populations of Substance Abusers with Special Problems KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 24. Substance abuse in adolescents can be a result of: 1. peer pressure and knowing who is dealing drugs. 2. family dysfunction and another family member who is using drugs. 3. wanting to feel part of their group and family dysfunction. 4. ineffective communication and denial. ANS: 3 Peer pressure and wanting to feel part of the group are powerful motivators for adolescents. If the family is dysfunctional, there is added reinforcement to abuse drugs and frequent opportunities to abuse. PTS: 1 DIF: Cognitive Level: Analysis REF: 1282 OBJ: 8 TOP: Adolescents KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 25. In some cases, patients will use drugs to treat the disturbing symptoms of psychiatric disease. This presents a problem, because there is the potential to: 1. cause a mixed drug reaction, which may have the effect of heightening both drug effects. 2. decrease psychiatric symptoms, which makes the condition harder to treat. 3. cause an accidental overdose by mixing alcohol with anxiolytic medications, antipsychotic medications, or antidepressant agents. 4. cause an increase in psychiatric symptoms, because the psychiatric drugs become less effective in the presence of alcohol. ANS: 3 Combining alcohol and psychiatric drugs, anxiolytics, or antidepressants may cause an accidental overdose by increasing the central nervous system (CNS) effects. PTS: 1 DIF: Cognitive Level: Analysis REF: 1283 OBJ: 8 TOP: The Dually Diagnosed KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. The nurse clarifies that when a urine sample is needed for screening in a case of DWI or other crime, the specimen should (select all that apply):
1. be collected and witnessed by a staff member of the same gender. 2. be documented with a chain of custody form, signed by all who handle the specimen. 3. be kept under secure conditions if temporary storage is necessary. 4. never be out of sight until someone from law enforcement takes it. 5. be placed in a specially marked container. ANS: 1, 2, 3 The specimen, if placed in secure storage, does not have to be in sight nor does it need a specially marked container. PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Application 2 TOP: Urine Screening Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 1268
2. The nurse documents signs of Wernickes encephalopathy in a patient with long-term alcoholism. These signs include (select all that apply): 1. confabulation. 2. ataxia. 3. delirium. 4. decreasing level of consciousness. 5. projectile vomiting. ANS: 1, 2, 3, 4 The signs of Wernickes encephalopathy do not include projectile vomiting.a PTS: 1 DIF: Cognitive Level: Application REF: 1269 OBJ: 5 TOP: Wernicke's Encephalopathy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity COMPLETION 1. The nurse explains that a test that can detect substance abuse for up to 1 year after only 2 or 3 days of use is done on ____________________. ANS: Hair PTS: OBJ: KEY: MSC: 1 DIF: Cognitive Level: Comprehension 2 TOP: Hair Analysis Nursing Process Step: Implementation NCLEX: Safe, Effective Care Environment REF: 1268
2. The nurse explains that because the drug disulfiram (Antabuse) is deemed inappropriate, the patient has been put on the most reliable substitute, ____________________, which causes similar but less severe side effects in the alcoholic who continues to drink. ANS: Flagyl
PTS: OBJ: KEY: MSC:
1 DIF: Cognitive Level: Application 5 TOP: Use of Flagyl Nursing Process Step: Implementation NCLEX: Physiological Integrity
REF: 1274