Chapter 24: Clients with Substance Abuse Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 24: Clients with Substance Abuse Disorders

MULTIPLE CHOICE

1. The theory that describes substance abuse as a learned behavior is called the

a.

biologic model.

b.

family system model.

c.

psychological model.

d.

sociocultural model.

ANS: C

The psychological models attempt to explain the variables that may predispose someone to substance use. Specifically, the behavioral model regards addiction as a behavior that can be unlearned.

DIF: Knowledge/Remembering REF: p. 433 OBJ: N/A

MSC: Psychosocial Integrity Coping and Adaptation-Chemical and Other Dependencies

2. A client who was admitted 2 days ago for assessment after a fall in his home has become increasingly irritable and now says there are bugs on his bed. He is diaphoretic and has a blood pressure of mm Hg. The nurse assesses

a.

alcohol-induced psychosis.

b.

delirium tremens.

c.

neurologic injury related to the fall.

d.

post-traumatic stress reaction.

ANS: B

During the 2 days after cessation of alcohol use, clients may experience delirium tremens (DTs), as evidenced by disorientation, nightmares, abdominal pain, nausea, and diaphoresis, as well as elevated temperature, pulse rate, and blood pressure measurement and visual and auditory hallucinations.

DIF: Application/Applying REF: p. 438 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

3. To prevent a severe withdrawal reaction from alcohol, the nurse explains that drugs from the benzodiazepine group are given because these agents

a.

cause less nausea and vomiting.

b.

cause less respiratory depression.

c.

inhibit the urge to drink.

d.

raise the blood pressure.

ANS: B

The benzodiazepines are often used because these drugs cause less respiratory depression and hypertension.

DIF: Comprehension/Understanding REF: p. 438 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

4. For a client experiencing alcohol withdrawal, the action that the nurse would include in the clients plan of care is to

a.

describe how the alcohol is causing the withdrawal effects.

b.

leave the client by him/herself so as not to cause agitation.

c.

promote a safe, calm, and comfortable environment.

d.

refer the client to an alcohol-abuse counselor.

ANS: C

The major nursing interventions for a client experiencing withdrawal focus on continuous monitoring of clinical manifestations and promoting a safe, calm, and comfortable environment. Safety is a key concern. After the withdrawal period is over is when the nurse could provide referrals or discuss the relationship of alcohol to physical problems. Do not leave the client alone as many clients will need reassurance that they will survive the ordeal of withdrawal.

DIF: Application/Applying REF: p. 439 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

5. The assessment by the nurse that would be significant to help prevent a complication from amphetamine use is to

a.

check oxygen levels frequently.

b.

keep the lights on continuously.

c.

measure intake and output.

d.

perform neurologic assessments.

ANS: D

The nurse should closely monitor the client taking amphetamines for changes in cardiac or neurologic status, since myocardial infarction and cerebral hemorrhage have occurred from amphetamine use.

DIF: Application/Applying REF: p. 440 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

6. The nurse reminds the client that in the United States, the most widely used psychoactive substance is

a.

alcohol.

b.

amphetamines.

c.

caffeine.

d.

marijuana.

ANS: C

The most frequently used psychoactive substance in the United States is caffeine.

DIF: Comprehension/Understanding REF: p. 440 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

7. The nurse evaluates that the client has learned an important fact about cocaine use when he says

a.

Cocaine is not addictive. I can use it as a recreational drug.

b.

Cocaine withdrawal is relatively easy. There is only mild fatigue.

c.

I know a young person can have a heart attack from using cocaine.

d.

Since cocaine is a depressant, one should not drive under its influence.

ANS: C

Cocaine is a stimulant and can cause myocardial infarction in young people. Cocaine is highly addictive, and withdrawal results in excessive exhaustion or crashing.

DIF: Evaluation REF: p. 441 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

8. A young man is brought to the emergency department after having a seizure at home. Assessment reveals a blood pressure of mm Hg, a respiratory rate of 6 breaths/min, and cardiac dysrhythmias. The most appropriate question the nurse should ask the clients friend is

a.

Does he take amphetamines or uppers?

b.

Has he ever used LSD?

c.

Have you two been out of the country in the last 2 days?

d.

Is he using any opioids such as heroin?

ANS: D

The clinical manifestations of an opioid overdose include seizures, shock, respiratory depression, dysrhythmias, and altered level of consciousness. An opioid overdose is a medical emergency. Amphetamine overdose is ruled out because it causes hypertension and CNS disturbances such as paranoia, panic, and delusions. LSD overdose would also manifest with hypertension and tachypnea along with hallucinations and possible loss of contact with reality. Travel outside the country is unrelated.

DIF: Analysis/Analyzing REF: p. 442 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

9. During history-taking, a client tells the nurse that he is addicted to caffeine and that he drinks 10 to 12 cups of coffee a day as well as several cola drinks and iced tea. The nurse would warn the client that during his NPO status for surgery, he should expect to experience

a.

diarrhea.

b.

euphoria.

c.

headache.

d.

itching.

ANS: C

Headache is a major withdrawal manifestation of caffeine.

DIF: Comprehension/Understanding REF: pp. 440, 444-445

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. The school nurse is called into an art class by the teacher to observe a student who is smiling and giggling as he sprays fixative on his charcoal picture. The students eyes and nose are red, and he is coughing. The school nurse assesses that the student may be experiencing

a.

a seasonal cold.

b.

an allergic reaction.

c.

inhalant abuse.

d.

use of an opioid.

ANS: C

Manifestations of inhalant abuse are euphoria, red nose and mouth, and coughing. Common solvents are glue, paint thinner, and aerosols.

DIF: Application/Applying REF: pp. 441, 444-445

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. When the school nurse hears a student conversation that is centered on having some hog, the nurse knows the students are referring to

a.

going on a cigarette break.

b.

inhaling nitrous oxide.

c.

injecting heroin.

d.

taking phencyclidine (PCP).

ANS: D

Hog is the street name for PCP.

DIF: Comprehension/Understanding REF: pp. 444-445 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Chemical and Other Dependencies

12. The nurse explains that disorienting flashbacks may be experienced by a client under the influence of

a.

alcohol.

b.

cocaine.

c.

heroin.

d.

LSD.

ANS: D

Suicide, homicide, and other acts of violence have been reported in persons under the influence of hallucinogenic drugs, such as lysergic acid diethylamide (LSD). Some users also experience flashbacks.

DIF: Comprehension/Understanding REF: p. 441 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Chemical and Other Dependencies

13. The nurse recognizes a potential health threat to an alcoholic client who is using the drug disulfiram (Antabuse) when the nurse reads in the health record that the client is also taking

a.

Coumadin.

b.

diphenhydramine (Benadryl) tablets.

c.

Milk of Magnesia.

d.

penicillin.

ANS: A

Antabuse increases the effect of anticoagulants such as warfarin (Coumadin).

DIF: Analysis/Analyzing REF: p. 438 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

14. A client taking the drug ReVia for alcohol abuse tells the nurse that he wants to join AA as an added support for his recovery. The nurses best response would be

a.

Although AA is a support toward sobriety, the fact that you are presently taking ReVia would probably make you ineligible for membership.

b.

AA has been able to help many people stay sober, but it does require that you have a sponsor. Do you know of someone who is a member?

c.

Joining AA is going to involve your family to some degree. Have you discussed your plans with them?

d.

That sounds like a very good idea. Shall we try to locate a chapter near you and see when they meet?

ANS: A

At present, Alcoholics Anonymous (AA) philosophy maintains that its members must be drug free and practice total abstinence. The use of any drug is seen by AA as a crutch or substitution for the alcohol.

DIF: Comprehension/Understanding REF: p. 439 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

15. The nurse teaching a client taking disulfiram (Antabuse) should focus on

a.

abstaining from alcohol ingestion.

b.

daily exercise.

c.

emotional support for the family.

d.

skin care.

ANS: A

Instruct the client taking disulfiram not to ingest any alcohol or use any products containing alcohol for 12 hours before taking Antabuse, while taking Antabuse, and for at least 14 days after discontinuing Antabuse.

DIF: Application/Applying REF: p. 438 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

16. A nurse works with another nurse who has been coming to work with red eyes and flushed face and is increasingly irritable. Which action by the nurse is most appropriate?

a.

Ask another co-worker what he/she thinks about the situation.

b.

Document questionable incidents and relay them to the manager.

c.

Leave the co-worker alone as it is obvious he/she has personal problems.

d.

Work alongside the colleague so there are no mistakes.

ANS: B

This nurse shows signs of impairment. An impaired nurse cannot meet the requirements of any state nurse practice act. At the very least, incidents should be documented and shared with management. The nurse may be asked to participate in an intervention. Some states require nurses report impaired colleagues. In any event, the nurse must obtain treatment.

DIF: Application/Applying REF: p. 448 OBJ: N/A

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

MULTIPLE RESPONSE

1. Primary prevention activities a nurse can perform related to substance abuse include (Select all that apply)

a.

education to prevent substance abuse.

b.

focusing on relapse prevention.

c.

identification of risk factors for abuse.

d.

medical detoxification.

e.

referral to support and self-help groups.

ANS: A, C

Primary prevention actions are those taken in order to prevent the problem from occurring. Options a and c clearly do this. Option e might be primary prevention if the self-help or support group was a group a client could join to reduce a stressful situation before the client turns to drug abuse. Secondary prevention includes screening and early detection for prompt treatment. Referral to a support group might be considered secondary if a client screened positive for substance abuse and the client agreed to start attending a group. Tertiary prevention includes rehabilitative strategies and would include options b and d, and possibly e if the support group focused on staying clean and returning to a functioning role in society.

DIF: Application/Applying REF: p. 447 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Chemical and Other Dependencies

2. Strategies that a nurse could suggest a client use to prevent a relapse into substance abuse include (Select all that apply)

a.

assessing and building on coping skills.

b.

changing environmental triggers to abuse substances.

c.

considering therapy for struggles with daily functioning.

d.

identifying the personal risks of relapse.

e.

participating in self-help groups.

ANS: A, B, C, D, E

All are good options. See Box 24-6 for more relapse-preventing strategies.

DIF: Application/Applying REF: p. 439 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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