Chapter 57: Substance-Related and Addictive Disorders Nursing School Test Banks

Chapter 57: Substance-Related and Addictive Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A patient has been diagnosed with alcoholism. A 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 which theory?
a. Biologic
b. Behavioral
c. Sociocultural
d. Intrapersonal
ANS: A
The biologic approach is based on the theory that there is a faulty physiologic process that causes a predisposition to an addiction. This theory includes the belief that such an addition is incurable and only total abstinence will be effective.

DIF: Cognitive Level: Comprehension REF: p. 1306 OBJ: 1
TOP: Etiology and Risk Factors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. A nurse explains that according to the intrapersonal theory, addiction is caused by early childhood rejection. These substance abusers are thought to have common characteristics. What do these characteristics include?
a. Open-boundary approach to life that likes to party frequently
b. Attention seeking, need for control, and self-centeredness
c. Shyness and anxiety
d. Stress and eagerness to be a part of the in-group
ANS: B
The intrapersonal theory identifies the common personality traits of self-centeredness, need for control, and attention seeking as parts of the addictive personality.

DIF: Cognitive Level: Comprehension REF: p. 1307 OBJ: 1
TOP: Etiology and Risk Factors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

3. During the taking of a medical history, a patient who is addicted to heroin reports he only uses the drug a few times a week. What is the nurses best response when trying to disclose more precise information?
a. OK. You only use heroin two times a week?
b. What do you mean when you say a few?
c. Are you saying that in a weeks time would you use heroin only two times?
d. Rate your weekly usage on a scale of 1 to 15.
ANS: D
When trying to get a health history on a patient with a substance abuse problem, the best method is an open discussion of the drug use. The discussion should be open and nonjudgmental. By requesting a scale, the patients response will be more informative.

DIF: Cognitive Level: Application REF: p. 1309 OBJ: 6
TOP: Nursing Assessment of the Substance Abuser
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A patient who is has alcoholism with a history of heavy drinking is brought to the inpatient psychiatric unit saying that he does not know where he is or what day it is. What should the nurse suspect he is exhibiting?
a. Delirium
b. Alcoholic dementia
c. Blackout
d. Amnesia
ANS: C
Blackouts are common with heavy drinking over time. The patient data support that the memory loss is associated with the alcohol use and that blackouts would be an expected outcome.

DIF: Cognitive Level: Comprehension REF: p. 1309 OBJ: 3
TOP: Patterns and Consequences of Abuse
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A nurse is discharging a patient with a pulmonary disorder to return home with her family. She has had a difficult time while in the hospital and has experienced withdrawal from tobacco. When the nurse tells her that community resources are available to help her to stop smoking, she says, Thats OK. I can stop whenever I want to. What does this exemplify?
a. Rationalization
b. Denial
c. Intellectualization
d. Projection
ANS: B
Denial is a common defense mechanism used by substance abusers.

DIF: Cognitive Level: Application REF: p. 1309 OBJ: 3
TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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. What does this exemplify?
a. Rationalization
b. Denial
c. Intellectualization
d. Projection
ANS: D
The patient in this scenario is projecting. He is blaming his wife for his drinking problem, rather than accepting that the drinking is his problem.

DIF: Cognitive Level: Application REF: p. 1309-1310
OBJ: 3 TOP: Defense Mechanisms
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

7. Which information about a patient should lead a nurse to suspect substance abuse?
a. Abnormal liver function test result and a gastrointestinal (GI) bleed
b. Positive syphilis screening result and varicose veins
c. Fungal infection and a potassium level of 4.2. mEq/L
d. Decreased albumin level and creatinine level of 1.2 mg/dL
ANS: A
An abnormal liver function test result and a gastrointestinal bleed indicate substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 1310 OBJ: 5
TOP: Diagnostic Tests KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. A urine drug screen is ordered for a patient suspected of a driving while intoxicated (DWI). What drugs are included in this screening?
a. Lysergic acid diethylamide (LSD), Valium, and Percocet
b. Crack, heroin, and nonsteroidal antiinflammatory drugs (NSAIDs)
c. Marijuana, amphetamines, and Elavil
d. Librium, cocaine, and Zoloft
ANS: A
LSD, Valium, and Percocet have the correct combination of an illicit drug, an anxiolytic medication, and an opioid.

DIF: Cognitive Level: Knowledge REF: p. 1310 OBJ: 5
TOP: Urine Drug Screening KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. An alcoholic is brought into the emergency department in an intoxicated state at 2000. The day shift nurse assesses the patient to exhibit tremors, have increased blood pressure, and agitation at 0800 rounds. What do these signs and symptoms indicate?
a. Major withdrawal
b. Early withdrawal
c. Delirium tremens
d. Minor withdrawal
ANS: B
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.

DIF: Cognitive Level: Comprehension REF: p. 1313 OBJ: 3
TOP: Alcoholism KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. Which syndrome of alcoholism is related to thiamine deficiency?
a. Fetal alcohol syndrome
b. Wernicke encephalopathy
c. Korsakoff psychosis
d. Alcoholic dementia
ANS: B
Wernicke encephalopathy is a vitamin B1 (thiamine) deficiency. If not treated with vitamin supplements, the condition can progress to a more serious form.

DIF: Cognitive Level: Knowledge REF: p. 1313 OBJ: 3
TOP: Medical Complications KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. A wife of a man with long-term alcoholism 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. What should this group be prepared to indicate during this confrontation?
a. He needs help; his drinking is out of hand.
b. They are fed up with him and will no longer be his friend.
c. They reject his drinking but think he is a valuable person.
d. He is still their friend even if he does not stop drinking.
ANS: C
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.

DIF: Cognitive Level: Comprehension REF: p. 1314 OBJ: 3
TOP: Implementation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

12. A nurse recommends to an alcoholic that he join Alcoholics Anonymous. What is true about this organization?
a. Based on a 12-step approach with a strong religious base
b. A social group of ex-drinkers who befriend one another in the process of maintaining sobriety
c. A religious support group that assists alcoholics during rehabilitation
d. An anonymous group of sponsors who offer help to alcoholics
ANS: A
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.

DIF: Cognitive Level: Comprehension REF: p. 1314 OBJ: 3
TOP: Rehabilitation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity: Coping and Adaptation

13. What should be avoided to prevent the accidental activation of Antabuse?
a. Aged cheese
b. Pickled foods
c. Mouthwash
d. Chocolate candy
ANS: C
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.

DIF: Cognitive Level: Application REF: p. 1317 OBJ: 3
TOP: Medications KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. A nurse in the admissions unit is informed that a patient is being brought in who has been using ice. What should the nurse assess?
a. Extreme dehydration
b. Coma
c. Dangerous hypertension
d. Violent behavior
ANS: D
Persons who use ice, a form of methamphetamine, are frequently violent while under its influence. The effect of ice can last as long as 12 to 14 hours.

DIF: Cognitive Level: Comprehension REF: p. 1319 OBJ: 3
TOP: Stimulants KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. An LPN is assisting with the development of a nursing care plan for a patient who has been using cocaine for 5 years. What should the nurse consider will most commonly need to be dealt with in this patient?
a. Depression
b. Violent behavior
c. Nasal erosion
d. Suicide attempts
ANS: A
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.

DIF: Cognitive Level: Comprehension REF: p. 1320 OBJ: 6
TOP: Cocaine KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. What might the positive effects of marijuana be used to treat?
a. Diet control in morbidly obese patients
b. Chemotherapy-induced nausea and vomiting
c. Air hunger in patients with end-stage emphysema
d. Early diabetic-induced cataracts
ANS: B
Marijuana has been studied for use to reduce nausea and vomiting in patients with cancer. Marinol (Dronabinol) is a marijuana derivative that is currently used to reduce chemotherapy-induced nausea and vomiting.

DIF: Cognitive Level: Comprehension REF: p. 1318 OBJ: 6
TOP: Hallucinogens KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

17. A nurse is counseling a pregnant cocaine abuser. What should the nurse inform this patient that she is placing her baby at significant risk for?
a. Severe allergies
b. Neurologic impairments
c. Hearing impairment
d. Higher birth weights
ANS: B
Babies born to mothers who are addicted to cocaine have a higher incidence of hyperactivity and neurologic problems.

DIF: Cognitive Level: Comprehension REF: p. 1320 OBJ: 7
TOP: Disorders Associated with Cocaine Use
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. What is the rationale for using methadone in the treatment of heroin abuse?
a. Substitutes one opioid for another
b. Is less constipating than heroin
c. Does not give the rush that a person addicted to heroin is looking for
d. Is a synthetic opioid, which makes it less addicting
ANS: C
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.

DIF: Cognitive Level: Application REF: p. 1321 OBJ: 3
TOP: Medications KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

19. Narcan has been given to a person with respiratory depression who is addicted to heroin. What should the nurse be alert for indications of?
a. Acute withdrawal symptoms
b. Respiratory arrest
c. Hypotensive crisis
d. Cardiac arrest
ANS: A
Narcan is an opioid antagonist that causes the opioid to fall from receptor sites. When the antagonist is given, the sudden loss of the opioid causes acute withdrawal to occur.

DIF: Cognitive Level: Application REF: p. 1322 OBJ: 3
TOP: Medications: Narcan KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. Two treatment plans for abusers of alcohol and drugs are similar90 meetings in 90 days and 12-step programs. What is the major difference in the success of the two types of programs?
a. One program uses a 12-step approach, and the other program has a religious base.
b. Heroin addicts have a higher success rate.
c. Alcohol abusers have an easier time staying with the program.
d. Relapse rates for patients using drugs other than alcohol alone are much higher.
ANS: D
One difference between alcohol and drug rehabilitation programs is that drug abusers will have a lower success rate. Alcohol abusers have a higher rate of success when they follow the Alcoholics Anonymous program.

DIF: Cognitive Level: Comprehension REF: p. 1322 OBJ: 6
TOP: Rehabilitation KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

21. Which nursing diagnosis is appropriate for a patient with substance abuse?
a. Anxiety
b. Chronic or situational low self-esteem
c. Risk for delayed development
d. Acute confusion
ANS: B
Low self-esteem is related to a loss of control and guilt.

DIF: Cognitive Level: Application REF: p. 1323 OBJ: 6
TOP: Nursing Diagnosis: Substance Abuse
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

22. Which implementation can be used to help prevent relapse in a patient who has a substance abuse problem?
a. Self-hypnosis
b. Imagery
c. Stress management
d. Blocking
ANS: C
Teaching stress management techniques to patients who have a substance abuse problem will assist them in managing the conflict and stress in their daily lives, which previously triggered the substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 1324 OBJ: 6
TOP: Implementation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

23. In some cases, patients will use drugs or alcohol to treat the disturbing symptoms of a psychiatric disease. What can occur in this scenario?
a. A mixed-drug reaction, which may heighten the effects of both drugs
b. Decreased psychiatric symptoms, which makes the psychiatric condition harder to treat
c. An accidental overdose by mixing alcohol with anxiolytic medications, antipsychotic medications, or antidepressant agents
d. An increase in psychiatric symptoms because the psychiatric drugs become less effective in the presence of alcohol
ANS: C
Combining alcohol and psychiatric drugs, anxiolytics, or antidepressants may cause an accidental overdose by increasing the central nervous system effects.

DIF: Cognitive Level: Application REF: p. 1325-1326
OBJ: 7 TOP: The Dually Diagnosed
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

24. A nurse indicates that a urine sample is needed for screening in a case of DWI. What actions should be implemented? (Select all that apply.)
a. Collection and witnessing by a staff member of the same gender
b. Documented with a chain-of-custody form signed by all who handle the specimen
c. Keep specimen under secure conditions if temporary storage is necessary
d. Never be out of sight until someone from law enforcement takes it
e. Place in a specially marked container
ANS: A, B, C
The specimen, if placed in secure storage, does not have to be in sight nor does it need a specially marked container.

DIF: Cognitive Level: Application REF: p. 1310 OBJ: 5
TOP: Urine Screening KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Prevention and Early Detection of Disease

25. A nurse documents signs of Wernicke encephalopathy in a patient with long-term alcoholism. What do these signs include? (Select all that apply.)
a. Confabulation
b. Ataxia
c. Delirium
d. Decreasing level of consciousness
e. Projectile vomiting
ANS: A, B, C, D
The signs of Wernicke encephalopathy do not include projectile vomiting.

DIF: Cognitive Level: Knowledge REF: p. 1313 OBJ: 5
TOP: Wernicke Encephalopathy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. What does alcohol abuse in the older adult place him or her at risk for? (Select all that apply.)
a. Falls
b. Malnutrition
c. Respiratory infections
d. Bone demineralization
e. Cirrhosis
ANS: A, B, D, E
Alcohol abuse in the older adult makes the person at risk for falls, malnutrition, cirrhosis, and bone demineralization.

DIF: Cognitive Level: Knowledge REF: p. 1324 OBJ: 7
TOP: Alcohol Abuse in the Older Adult KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. What is true regarding hair analysis done on an alcoholic? (Select all that apply.)
a. Requires sensitive technology
b. Is not reliable on treated or dyed hair
c. Can determine addiction
d. Can be informative in the treatment of a short-term abuser
e. Can assess relapse
ANS: A, E
Hair analysis requires sensitive technology, can be used on treated or dyed hair, and can assess a relapse. Hair analysis cannot confirm addiction, only use, and it is not informative on short-term abusers.

DIF: Cognitive Level: Knowledge REF: p. 1310 OBJ: 2
TOP: Hair Analysis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

28. What factors make the adolescent extremely vulnerable to substance abuse (Select all that apply.)
a. Egocentricity
b. Ability to use good judgment
c. Poor impulse control
d. Awareness of possible consequences
e. Desire for peer identification
ANS: A, C, E
Adolescents are prone to substance abuse because of peer pressure and their basic egocentrism, which interferes with good judgment, prediction of consequences, and impulse control.

DIF: Cognitive Level: Comprehension REF: p. 1325 OBJ: 7
TOP: Adolescents KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

COMPLETION

29. A nurse explains that a test that can detect substance abuse for up to 1 year after only 2 or 3 days of use is performed on _____.

ANS:
hair
Hair can indicate drug abuse up to a year even if the abuse was only a matter of days.

DIF: Cognitive Level: Knowledge REF: p. 1310 OBJ: 2
TOP: Hair Analysis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. A 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 people with alcoholism who continue to drink.

ANS:
Flagyl
Metronidazole (Flagyl), similar to Antabuse, can also cause nausea and severe vomiting if mixed with alcohol.

DIF: Cognitive Level: Knowledge REF: p. 1317 OBJ: 2
TOP: Use of Flagyl KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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