Chapter 13 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 13

Question 1

Type: MCSA

A patient tells the nurse that both his parents are alcoholics, and he wonders about the likelihood of becoming an alcoholic as well. How should the nurse respond?

1. There are studies that support a genetic link for developing alcoholism.

2. Why are you concerned about becoming an alcoholic?

3. You will likely become an alcoholic.

4. Dont worry about that.

Correct Answer: 1

Rationale 1: Genetic studies suggest that heredity plays a role in the development of alcoholism.

Rationale 2: The nurse should not question the patients request for information about becoming an alcoholic like his parents.

Rationale 3: Although the patient does have an increased risk, stating that he will become an alcoholic is inappropriate.

Rationale 4: Telling the patient not to worry about becoming an alcoholic is an inappropriate response.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-1

Question 2

Type: MCSA

The mother of a patient admitted with alcohol abuse tells the nurse that alcohol is not consumed at home and the patient is adopted. How would the nurse evaluate this information?

1. The patients biological parents might have abused alcohol.

2. The patient spends time drinking with friends.

3. Consuming alcohol is a symptom of stress.

4. Alcoholism is a learned behavior.

Correct Answer: 1

Rationale 1: Genetic studies suggest that heredity plays a role in the development of alcoholism. Because the patient was adopted, the patients biological parents may have abused alcohol.

Rationale 2: There is not enough information to conclude that the patient is drinking with friends.

Rationale 3: There is not enough information to conclude that the patient is consuming alcohol because of stress.

Rationale 4: There is not enough evidence to conclude that the patients alcohol use is learned behavior.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

Question 3

Type: MCSA

A patient tells the nurse that she started to have a glass of wine every evening at home after work to unwind and then realized that she cannot continue with her day unless she has the wine. The nurse realizes that this patient uses wine for which reason?

1. To cope with day-to-day problems

2. To deal with difficulty expressing emotions

3. To suppress a genetic need for alcohol

4. To socialize with others

Correct Answer: 1

Rationale 1: Psychological factors in substance abuse include the use of the substance as self-medication to cope with day-to-day problems that over time becomes an addiction.

Rationale 2: There is no information to suggest that the patient is having difficulty expressing emotions.

Rationale 3: There is no information to suggest that the patient has a genetic need for alcohol.

Rationale 4: The patient is drinking at home after work.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

Question 4

Type: MCSA

The nurse is concerned about possible substance abuse by a coworker. Which behavior warrants further investigation?

1. The coworker frequently wastes medications.

2. The coworker frequently requests the largest patient care assignment for the shift.

3. The coworker prefers not to be the medication nurse on the shift.

4. The coworker declines to take scheduled breaks.

Correct Answer: 1

Rationale 1: Excessive waste of medications could be a sign that a nurse is using or diverting drugs.

Rationale 2: Requesting a large patient care assignment would not be characteristic of a nurse who is abusing substances. The nurse who is unable or unwilling to manage a patient care assignment could be a substance abuser.

Rationale 3: Requesting not to be the medication nurse would reduce access to drugs subject to abuse.

Rationale 4: Taking frequent or lengthy breaks might signal substance abuse. Declining scheduled breaks is not consistent with substance abuse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 5

Type: MCSA

A nurse frequently cannot be found on the unit when patients call for assistance. When colleagues mention these absences, the nurse becomes defensive and withdraws from the others. What does the nurses behavior suggest?

1. Substance abuse

2. A long-standing illness

3. Introverted behavior

4. Low self-esteem

Correct Answer: 1

Rationale 1: Signs of drug abuse include frequent disappearance from the work area. The defensive behavior and isolation are also signs of substance abuse.

Rationale 2: There is insufficient information to support long-standing illness as a reason for the nurses behavior.

Rationale 3: There is insufficient information to support introverted behavior as a reason for the nurses behavior.

Rationale 4: There is insufficient information to support low self-esteem as a reason for the nurses behavior.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 6

Type: MCMA

The nurse manager is concerned that a staff nurse is demonstrating signs of substance abuse. Which behaviors did the manager observe in the staff nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Calling for days off or illness before scheduled days off

2. Using the bathroom frequently

3. Offering to give medication to patients not assigned to the nurse

4. Volunteering to transfer a patient to the intensive care unit

5. Following up with nursing assistants on patient care needs

Correct Answer: 1,2,3

Rationale 1: Observable warning signs of potential substance abuse include calling for days off before scheduled days off.

Rationale 2: Observable warning signs of potential substance abuse include frequent absence from the assigned work area.

Rationale 3: Observable warning signs of potential substance abuse include offering to give medications to patients not assigned to the nurse.

Rationale 4: Volunteering to transfer a patient to the intensive care unit is not an indication of substance abuse.

Rationale 5: Following up with nursing assistants on patient care needs is an expected part of the nurses job, not an indication of substance abuse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 7

Type: MCSA

A community pharmacist calls the clinic and reports that a patient has asked for pain medication refills early for the last 2 months. What action should be taken by the nurse?

1. Notify the health care provider that the patient has lost control of his or her consumption of medication.

2. Tell the pharmacist to refill the prescriptions early.

3. Ask the pharmacist if the patient has received medications early from any other provider.

4. Notify the health care provider of the patients request.

Correct Answer: 4

Rationale 1: The nurse does not have sufficient information to make this assumption.

Rationale 2: This decision is not within the nurses scope of practice.

Rationale 3: This is not the best course of action for the nurse and may violate HIPAA regulations.

Rationale 4: There may be a valid reason the patient needs the medication earlier than is prescribed. The prescriber should make a decision according to the patients history.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

Question 8

Type: MCSA

A patient is brought to the emergency department with a gunshot wound inflicted while attempting to steal beer from a convenience store. Which statement by the patient would reflect a sociocultural influence on the patients behavior?

1. My dad was killed while driving drunk before I was even born.

2. I didnt take anything out of that store. The manager is just trying to pin something on me.

3. There was lots of beer in that store. I didnt see how taking one six-pack would hurt anything.

4. I cant have fun at a party without beer.

Correct Answer: 4

Rationale 1: The nurse could surmise from this information that the patient has a biological predisposition toward alcohol abuse.

Rationale 2: Inner dishonesty is a common trait among substance abusers. This is related to the psychological theory of substance abuse.

Rationale 3: Self-centeredness is a common trait among substance abusers. This is related to the psychological theory of substance abuse.

Rationale 4: Some abusers use substances to help cope with stressful situations or to fit in with a crowd. This behavior is consistent with sociocultural theory.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

Question 9

Type: MCSA

A patient tells the nurse that he becomes very angry and abusive to his friends and family when he is unable to obtain an illegal substance. How should the nurse respond?

1. Have you considered seeking treatment for this behavior?

2. You must not have many friends left.

3. Have your actions caused problems for you at work?

4. I dont see how that kind of behavior helps get you what you want.

Correct Answer: 1

Rationale 1: The patients description indicates a substance abuse problem. The best response is for the nurse to ask the patient if he has considered seeking treatment for this behavior.

Rationale 2: The nurse should not comment about the patients number of friends.

Rationale 3: The patient has reported that he is abusive to friends and family. Whether this behavior has caused problems at work is not the most important assessment question.

Rationale 4: Confronting the patient about how illogical his actions are is not the most therapeutic or safest course of action.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-1

Question 10

Type: MCSA

A patient who is a recovering alcoholic says, I havent had a drink in 10 days. I think I am over the hardest part and will be okay now. The nurse formulates a response based on which information?

1. Symptoms of postacute withdrawal syndrome begin about a month after the last drink.

2. Symptoms of postacute withdrawal syndrome peak from 3 to 6 months after the last drink.

3. The recovering alcoholic is never okay again.

4. It is easier to recover from cocaine abuse than from alcohol abuse.

Correct Answer: 2

Rationale 1: Postacute withdrawal syndrome begins about 1 to 2 weeks after the last exposure to the substance.

Rationale 2: Postacute withdrawal syndrome symptoms peak at 3 to 56 months after the last exposure to the substance.

Rationale 3: Alcoholism is a long term illness, but people do recover from it and could be characterized as okay.

Rationale 4: Any type of abuse recovery takes work and it is not accurate to gauge the difficulty of one recovery against another.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-1

Question 11

Type: MCSA

A patient involved in a minor accident reports using crank an hour ago. The patient denies having used the drug before. Which manifestation can the nurse anticipate assessing in this patient?

1. Feelings of increased energy and happiness

2. Increased strength and coordination

3. Drowsiness

4. Delusional accusations

Correct Answer: 1

Rationale 1: Crank is a form of methamphetamine that gives rise to feelings of increased energy and euphoria. These are the patients impressions and are not based in reality.

Rationale 2: The patient will not display increased strength and coordination.

Rationale 3: Drowsiness is an uncommon finding in an individual who has used crank for the first time.

Rationale 4: Delusional accusations might be made by an individual who has been using crank for a long period.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

Question 12

Type: MCSA

A patient admitted with seizures is diagnosed with a perforated nasal septum. The nurse realizes that this patient most likely has abused which substance?

1. Cocaine

2. Marijuana

3. Alcohol

4. Barbiturates

Correct Answer: 1

Rationale 1: Long-term intranasal use of cocaine is associated with a perforated nasal septum. Severe cocaine overdose can lead to a seizure disorder.

Rationale 2: Seizures and a perforated nasal septum are not associated with marijuana use.

Rationale 3: Seizures and a perforated nasal septum are not associated with alcohol abuse.

Rationale 4: Seizures and a perforated nasal septum are not associated with barbiturate abuse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

Question 13

Type: MCSA

A teenager who is brought to the emergency department by the parents is reported to have taken barbiturates with alcohol. What will be the greatest concern for this patient?

1. Respiratory depression

2. Seizure activity

3. Signs of withdrawal

4. Hallucinations

Correct Answer: 1

Rationale 1: Barbiturates are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The patient who has ingested both is at risk for varying degrees of sedation, up to coma and death.

Rationale 2: Seizure activity is not the greatest risk for this patient.

Rationale 3: Signs of withdrawal are not the greatest risk for this patient.

Rationale 4: Hallucinations are not the greatest risk for this patient.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

Question 14

Type: MCSA

A patient comes to the emergency department with a PCP overdose. Which intervention can the nurse anticipate the patient will require?

1. Administering a benzodiazepine as prescribed

2. Inducing vomiting

3. Assisting with lavage

4. Administering Narcan as prescribed

Correct Answer: 1

Rationale 1: PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The nurse should anticipate administering a benzodiazepine as prescribed.

Rationale 2: Inducing vomiting is not appropriate treatment for PCP overdose.

Rationale 3: Lavage is not indicated for PCP overdose.

Rationale 4: Narcan is not used to treat PCP overdose.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-2

Question 15

Type: MCSA

A patient with a history of chronic alcohol abuse is underweight and malnourished. Which drug may be prescribed to manage the patients nutritional status?

1. Vitamin B1

2. Warfarin

3. Methadone

4. Narcan

Correct Answer: 1

Rationale 1: Vitamins, especially B vitamins, are not metabolized well in an alcoholics body and must be replenished.

Rationale 2: The administration of warfarin is not indicated for this patient.

Rationale 3: Methadone is prescribed to manage heroin cravings.

Rationale 4: Narcan is used to treat the effects of central nervous system depression.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-2

Question 16

Type: MCMA

A patient has been using amphetamines for the last 3 years and has been diagnosed with substance dependence. Which statements by the patient are associated with substance dependence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I am so tired and I feel so confused about everything that is happening around me.

2. I have really tried to cut down my use, but I fail miserably every time.

3. The only thing I care about right now is getting my fix.

4. I have to use a lot more right now to get the same high as before.

5. I have a great job where I work full-time as a mechanical engineer, so that part of my life is very fulfilling.

Correct Answer: 1,2,3,4

Rationale 1: Fatigue and confusion are withdrawal symptoms associated with the use of amphetamines.

Rationale 2: Unsuccessfully attempting to cut down on use of a substance is a behavior associated with substance dependence.

Rationale 3: A focus on obtaining the drug is a behavior associated with substance dependence.

Rationale 4: Persons with substance dependence are likely to develop tolerance to the drug.

Rationale 5: A patient with substance dependence is unlikely to keep a full-time job because of the time required to procure and use the drug. The patient invests less time in occupational activities.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 17

Type: MCMA

A patient has been admitted to an addiction detoxification unit. The nurse has educated the patient about the medications that have been prescribed to help with withdrawal symptoms. Which statements by the patient indicate that further education is required?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Naltrexone is an antidepressant.

2. The Antabuse will help me with my cravings for heroin.

3. Chlordiazepoxide is also called Librium, and it can help with my anxiety.

4. The phenobarbital will help prevent seizures.

5. I need folic acid and other vitamin supplements because I havent eaten well for so long.

Correct Answer: 1,2

Rationale 1: Naltrexone (ReVia) helps diminish cravings for alcohol and opiates. It is not an antidepressant.

Rationale 2: Antabuse is given to patients to stop the breakdown of alcohol within the body and make the consequences of drinking alcohol more severe. Methadone helps to block heroin cravings.

Rationale 3: Librium can be used to help with anxiety and prevent seizure activity.

Rationale 4: Phenobarbital can help prevent seizure activity.

Rationale 5: Vitamin supplements can help the patient with alcoholism, who has likely developed vitamin deficiencies.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 12-03

Question 18

Type: MCMA

A patient is exhibiting addictive behaviors and has admitted to using illegal drugs. Which statements by the patient are consistent with addictive behaviors?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. I think even as a child I didnt have much self-esteem.

2. When I was in the hospital for appendicitis, they told me they had to give me more pain medication than normal because I was still in pain.

3. Sometimes I steal things from stores just to see if I can get away with it.

4. I like to play it safe. When my friends were bungee jumping off the bridge, I just watched.

5. I have always been very slow to anger.

Correct Answer: 1,2,3

Rationale 1: People may turn to substance abuse because of low self-esteem.

Rationale 2: Substance abusers are more likely to have a low tolerance for pain.

Rationale 3: Substance abusers are more likely to participate in risky behaviors such as stealing.

Rationale 4: Substance abusers are more likely to participate in risky behaviors such as bungee jumping without regard for social norms or their own safety.

Rationale 5: Substance abusers are more likely to have problems with anger control than others who do not abuse substances.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-03

Question 19

Type: MCMA

The patient has been admitted to the hospital after a motor vehicle accident. The patient states that she frequently smokes ice and had smoked some as recently as 2 hours prior to the accident. Which assessment findings are consistent with this information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The apical heart rate is 112 beats per minute.

2. Premature ventricular contractions are noted during electrocardiogram.

3. The patient weighs 92 pounds and is 55 tall.

4. The patient is complaining of chest pain.

5. The patients blood pressure is 96/72.

Correct Answer: 1,2,3,4

Rationale 1: The patient is likely to exhibit tachycardia.

Rationale 2: The patient is likely to exhibit dysrhythmias.

Rationale 3: Because methamphetamine use suppresses appetite, the patient is likely to be thin.

Rationale 4: Angina is a common complaint among people who use methamphetamines.

Rationale 5: The patients blood pressure is likely to be elevated due to the vasoconstriction that is produced by this type of drug use.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 12-02

Question 20

Type: MCMA

Which assessment findings would the nurse evaluate as indicating substance dependence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient is exhibiting tolerance.

2. The patient spends significant amounts of time trying to obtain the substance.

3. The patient continues to use the substance after acknowledging it is not good for his health.

4. The patient describes several attempts to control substance use.

5. The patient continues to use the substance in spite of serious relationship problems.

Correct Answer: 1,2,3,4

Rationale 1: Substance dependence is demonstrated by tolerance to the drug.

Rationale 2: A patient who is dependent on a substance spends a significant amount of time trying to obtain it.

Rationale 3: Substance dependence is demonstrated by continuing to use the substance despite recognition of the associated problems and difficulties.

Rationale 4: The patient has made unsuccessful attempts to cut down or control use of the substance.

Rationale 5: Substance abuse, not dependence, is characterized by continued use despite social and relationship problems.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 21

Type: MCMA

The nurse is assessing a patient who reports frequent use of marijuana during her current pregnancy. The nurse would teach the patient about which effects of this drug?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Poor pregnancy outcomes

2. Bradycardia

3. Lung damage with long-term use

4. Diuresis

5. Increased risk of respiratory cancer

Correct Answer: 1,3,5

Rationale 1: The use of cannabis during pregnancy can cause poor pregnancy outcomes.

Rationale 2: There is no evidence that marijuana use results in bradycardia.

Rationale 3: Lung damage can occur with long-term use.

Rationale 4: Diuresis is not caused by cannabis.

Rationale 5: Persons who use marijuana on a long-term basis have a higher risk of respiratory cancer.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

Question 22

Type: FIB

A patient withdrawing from alcohol addiction has an order for diazepam (Valium), 10 mg every 4 hours for four doses, then 5 mg every 4 hours for four doses. The drug comes in a concentration of 5 mg/mL. The patient is given a total of ______ mL.

Standard Text:

Correct Answer: 12

Rationale : The drug comes in 5 mg/mL, and at 10 mg ordered, each dose is 2 mL. 2 mL x four doses = 8 mL. The four doses of 5 mg = 4 mL. 4 + 8 = 12.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-3

Question 23

Type: FIB

A loading dose of magnesium sulfate 4 g is ordered for a patient. The concentration available is 4 g/250 mL to be given over 30 minutes. The IV pump rate will be set at _______ mL/h.

Standard Text:

Correct Answer: 500

Rationale : 4g/30 min = x mL/h. 250mL/30 min = x mL/h. 250 mL/30 min x 2/2 = 500 mL/60 min = 500 mL/h.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-3

Question 24

Type: MCMA

The nurse should ask nonjudgmental questions when assessing a patient for substance abuse. Which questions would be appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. On average, how many days a week do you drink or use drugs?

2. How often and how much do you usually use?

3. When you drink alcohol, do you usually drink a pint or a quart?

4. You dont drink hard liquor, do you?

5. Why in the world did you ever start abusing prescription drugs?

Correct Answer: 1,2,3

Rationale 1: This question does not make a judgment that the patient does or does not drink.

Rationale 2: This is an open-ended question that does not judge the wisdom of using.

Rationale 3: This statement does not judge the patient for drinking either quantity. It also allows the patient to correct an overstatement.

Rationale 4: This statement may be interpreted as judgmental against hard liquor.

Rationale 5: This statement implies a judgment about the patients intelligence or self-control.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 25

Type: MCSA

A patient tells the nurse that he does not want to attend his wifes family events because he is expected to drink alcohol and he prefers not to. The nurse realizes this patient is describing behaviors found within which theory of substance disorders?

1. Sociocultural

2. Psychological

3. Biological

4. Metaphysical

Correct Answer: 1

Rationale 1: In the sociocultural framework, the roles different family members play and the importance of family rituals contribute to the problem of substance abuse and its treatment.

Rationale 2: The psychological theory explains how the psychological underpinnings of experiences and behaviors come together to form motivation to use drugs in a destructive manner.

Rationale 3: The biological theory supports a genetic explanation for substance abuse.

Rationale 4: There is no metaphysical theory for substance abuse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-1

Question 26

Type: MCSA

A young adult patient tells the nurse that he periodically uses uppers to keep awake while studying for college classes, so he does not understand why he has been feeling so depressed lately. How would the nurse interpret what the patient is experiencing?

1. Expected effects of the drug

2. Symptoms of a crash

3. Cocaine abstinence syndrome

4. Hallucinations

Correct Answer: 2

Rationale 1: Depression is not an expected effect of amphetamines when they are used appropriately.

Rationale 2: Tolerance for amphetamines develops rapidly, and withdrawing the substance can lead to a depressive episode or crash.

Rationale 3: Cocaine is not described as an upper.

Rationale 4: The feeling of depression is not a hallucination.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-2

Question 27

Type: MCSA

The nurse realizes the patient is describing tolerance when the patient makes which statement?

1. I think I have the flu. My stomach is upset and my hands are shaking.

2. If I have my drink before I go home, I dont lose my patience so easily.

3. I had a really good time at the party. At least my friends told me I did, but I dont remember much of it.

4. I seem to need more alcohol each evening just to unwind.

Correct Answer: 4

Rationale 1: These symptoms reflect withdrawal from the drug.

Rationale 2: This statement reflects substance abuse.

Rationale 3: This statement reflects substance abuse.

Rationale 4: Tolerance is a cumulative state in which a particular dose of the chemical elicits a smaller response than before. With increasing tolerance, the individual needs higher and higher doses to obtain the desired effects.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 13-3

Question 28

Type: MCSA

A patient is admitted with symptoms of alcohol withdrawal. Which intervention is the highest priority for this patient?

1. Encourage verbalization of feelings.

2. Support respiratory and cardiac status.

3. Keep the room dimly lit.

4. Encourage taking fluids by mouth.

Correct Answer: 2

Rationale 1: Encouraging verbalization of feelings is part of the care of patients in alcohol withdrawal but is not the highest priority.

Rationale 2: Substance abusers who are acutely ill are often treated in the medical-surgical unit of a general hospital. Life-threatening physiological symptoms are addressed first. Respiratory and cardiac status should be supported.

Rationale 3: Keeping the room dimly lit to reduce stimuli is important but is not the highest priority.

Rationale 4: Keeping the patient hydrated is important but is not the priority.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-2

Question 29

Type: MCSA

A patient tells the nurse that he gets off cocaine for a while and then in a few months finds himself hanging out in the same places where he knows he can easily get drugs. How should the nurse respond?

1. This will happen for the rest of your life. There isnt anything you can do to change it.

2. This is drug-seeking behavior and is a response to a craving. What can you do instead of going to the places where you can get drugs?

3. This is because you are an addict and need the drugs.

4. Have you considered using a less addictive type of drug instead of the kind you used to use?

Correct Answer: 2

Rationale 1: The nurse has no way of knowing if this behavior will continue for the rest of the patients life. The patient can learn coping mechanisms to replace the drug-seeking behavior.

Rationale 2: The patient is describing drug-seeking behavior. The nurse should suggest ways to cope with the craving by asking what the patient can do instead of going to the places where he knows he can get drugs.

Rationale 3: The nurse should not confront the patient this way.

Rationale 4: The nurse should not suggest that the patient replace one addictive drug with another.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 13-3

Question 30

Type: FIB

A patient has been admitted to withdraw from alcohol. The patient is agitated and restless and complains of having the shakes. The nurse anticipates this patient will experience these effects for at least _____ weeks.

Standard Text:

Correct Answer: 2

Rationale : During alcohol withdrawal, the duration of agitation, restlessness, tremulousness, and inner shakiness is about 2 weeks.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 13-2

 

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