Chapter 17: Substance Use and Addictive Disorders My Nursing Test Banks

Chapter 17: Substance Use and Addictive Disorders

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Poor impulse control, rapid speech, and hypertension are most characteristic of abusing which substance?

A.

Alcohol

B.

Heroin

C.

Cocaine

D.

LSD

____ 2. A new patient with a history of alcoholism is in the ER with agitation, vomiting, and tremors. He tells you he had his last drink 24 hours ago. Which medication would most likely be ordered?

A.

Chlordiazepoxide

B.

Disulfiram

C.

Chlorpromazine

D.

Naloxone hydrochloride

____ 3. Your patient has a long history of alcohol abuse. You know that denial is a frequently used defense mechanism. Which statement is indicative of denial?

A.

My father was a drinker so I guess that led me to this.

B.

I can stop anytime I want, I just dont feel like it now.

C.

Drinking calms my nerves.

D.

I drink when my kids upset me.

____ 4. Which of the following statements from an alcoholic patient reflects a good understanding of his or her condition?

A.

I will stick to wine or beer from now on.

B.

Ill be OK if my wife will just stop nagging me.

C.

I plan to take my sobriety 1 day at a time.

D.

I wont need AA after I am sober for 1 year.

____ 5. Your 42-year-old patient in the alcohol treatment unit tells you he often cant remember events while he was drinking. What is this most likely an example of?

A.

Denial

B.

Blackouts

C.

Psychosis

D.

Depression

____ 6. A teenager admits to you that he has been smoking marijuana. The nurse knows that marijuana is a(n):

A.

Cannabinol.

B.

Amphetamine.

C.

Hallucinogen.

D.

Narcotic.

____ 7. Which drug cannot be given if the patient reports alcohol intake in the last 24 hours?

A.

Chlorpromazine

B.

Chlordiazepoxide

C.

Disulfiram

D.

Risperidone

____ 8. Your patient in the ER waiting room is inebriated. He becomes increasingly loud and abusive while waiting to be seen. What would be the best intervention for the nurse?

A.

Tell him he has to wait his turn, as others were here first.

B.

Inform him he will be asked to leave if this behavior continues.

C.

Offer to take him to an exam room to wait for the doctor.

D.

Do nothing, as he is still in the waiting room.

____ 9. Your patient tells you her husband has a serious drinking problem. Which statement tells you she may be in a codependent relationship?

A.

Ive reached my limit with his drinking.

B.

I called his job and told them he was sick when he couldnt go to work.

C.

The kids are ashamed of their father. I feel bad about that.

D.

He is drinking less this week.

____ 10. What should be your response to the wife who says, I should get out of this bad situation with his drinking?

A.

That happened to me. Its best to get out while you can.

B.

Tell me more about the bad situation.

C.

Why dont you talk to your husband about his drinking?

D.

Youll do whats right.

____ 11. Your new patient is at risk for alcohol withdrawal. You know that alcohol withdrawal tends to develop within what period after the last drink?

A.

1 week

B.

24 to 48 hours

C.

1 hour

D.

More than 1 week

____ 12. The wife of your alcoholic patient has been attending Al-Anon meetings for the past 2 weeks. Which statement tells you the wife is benefitting from the meetings?

A.

I can tolerate his destructive behavior now that I see how bad other women have it.

B.

I realize that I provoke his drinking when I go out with my friends.

C.

I no longer feel that I have to tolerate his berating me.

D.

It is great to get out of the house and away from the tension.

____ 13. Which of the following are signs of withdrawal from heroin?

A.

Insomnia, muscle cramps, vomiting

B.

Excessive sleeping, low blood pressure, depression

C.

Seizures, brain damage, excessive sleeping

D.

Lethargy, panic disorder, increased appetite

____ 14. Mr. Thomas, who is 50 years old, is being treated for pneumonia and dehydration. He has a history of alcoholism and admits to starting to drink heavily again. He tells you, Im a horrible person. My family deserves someone better than me to care for them. Your most therapeutic response to him is:

A.

It sounds as though you are feeling guilty about drinking, Mr. Thomas. Tell me more about what you mean by that.

B.

Why do you say that, Mr. Thomas?

C.

Im sure that your family is satisfied, Mr. Thomas.

D.

Your drinking doesnt sound that serious.

____ 15. You are caring for a patient who has a long history of alcohol abuse. Recently, this patient went on a 5-day drinking binge, of which she has no memory. This is an example of:

A.

Selective memory.

B.

Wernickes syndrome.

C.

Blackout.

D.

Denial.

____ 16. Nurses understand that in people who are addicted to alcohol, the person who is most responsible for the patients recovery is the:

A.

Psychiatrist.

B.

Nurse.

C.

AA sponsor.

D.

Patient.

____ 17. You are socializing with a group of nurses who you work with on a routine basis. Terri is getting very loud and tells you that she usually has six or eight beers most evenings. She is defensive about your reaction to the amount of alcohol she consumes. She says, I have days where I cant remember what happened the night before, sure, but only once in a while. If you were Terris friend, the best action you could suggest to her would be:

A.

Maybe you should stop at four beers, Terri.

B.

I wont tell your husband what you told me.

C.

It sounds to me like your drinking is getting out of control. I cant continue to socialize with you if you continue to drink this much.

D.

Terri, I will call AA for you when you are ready.

____ 18. Randi is a young model. She had been taking high doses of amphetamines to keep her weight down. She recently decided to cut back on the drugs and she is now experiencing amphetamine withdrawal. She presented to the clinic with which of the following sets of symptoms of amphetamine withdrawal?

A.

Chest pain, palpitations, and diaphoresis

B.

Depression, vivid dreams, and confusion

C.

Euphoria, hyperactivity, and hyperalertness

D.

Diaphoresis, clammy palms, and diarrhea

____ 19. A young adult arrives in the after-hours clinic with dilated pupils, an elevated heart rate, extreme sensitivity to sounds around him, sense of being outside of his body, and fine tremors of the hands. The patient admits to recent use of an illegal street drug. As the nurse collecting this data, you suspect:

A.

LSD.

B.

Crack cocaine.

C.

Amphetamines.

D.

Downers.

____ 20. Alcohol is a(n):

A.

Central nervous system (CNS) stimulant.

B.

CNS depressant.

C.

Antipsychotic.

D.

Antidepressant.

____ 21. You are caring for a female patient who is a long-term alcoholic. She screams, Get the bugs off of my skin. I feel them all over my body! Get them off! She is experiencing what type of hallucination?

A.

Auditory

B.

Visual

C.

Taste

D.

Tactile

____ 22. A 35-year-old male patient signs in as a voluntary commitment for treatment for drug abuse. He strongly maintains that he does not have a problem and states, Im only here because my boss threatened to fire me if I didnt come in. The best nursing response to this patient is:

A.

I wonder why your boss said that, if you dont have a problem.

B.

What happened that your boss threatened to fire you?

C.

Your boss sounds pretty harsh!

D.

Well, you are here on your own, so you can leave whenever you want to.

____ 23. A patient has completed treatment for alcoholism. If treatment was successful, a nurse might expect which of the following outcome statements from this patient upon discharge?

A.

Now, if my family will just be good, I wont be back!

B.

I just know I can have an occasional drink and be fine. I know how to handle it now.

C.

I realize that Alcoholics Anonymous will always be a requirement. I am responsible for my own sobriety.

D.

I am so glad I found out what my problem is. I am cured now!

____ 24. Which of the following is a club drug?

A.

Rohypnal

B.

Crack

C.

Placidyl

D.

Angel dust

Completion

Complete each statement.

25. You are completing the discharge plan for an alcoholic patient. Which support group should be included in the plan? ___________________

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 26. You find out that your schizophrenic patient is also using opioids to counteract the frightening hallucinations. What term(s) is used to describe this? (Select all that apply)

A.

Dual diagnosis

B.

Bipolar schizophrenia

C.

Co-occurring disorder

D.

Opioid-related schizophrenia

E.

Schizophrenia: Addiction type

____ 27. Which of the following are true about Alcoholics Anonymous? (Select all that apply)

A.

A physician referral is needed.

B.

Family and friends are encouraged to attend the regular meetings with the alcoholic.

C.

No last names are used at the meetings.

D.

The group for family members is Al-Anon.

E.

Offshoots such as Narcotics Anonymous follow a different philosophy.

F.

The individual is encouraged to admit he or she is powerless over alcohol.

Chapter 17: Substance Use and Addictive Disorders

Answer Section

MULTIPLE CHOICE

1. ANS: C

These three symptoms are common with a stimulant such as cocaine. They could occur with the other substances but are not the hallmark symptoms.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 272

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Substance Abuse | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Chemical and other dependencies

2. ANS: A

This medication is often initially used to treat alcohol withdrawal symptoms. Response B is a treatment for alcoholism not withdrawal. Response C is an antipsychotic and response D is used in opioid addiction.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-2, Commonly Used Medications for Withdrawal Management; page 270

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Chemical and other dependencies

3. ANS: B

This response indicates the person is minimizing or not acknowledging that he or she has a problem. In the other responses the patient is acknowledging drinking but rationalizing the causes.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-4, Common Coping Styles of Substance Abusers; page 279

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Coping mechanisms

4. ANS: C

Responses A, B, and D all reinforce use of ineffective defense mechanisms, including denial, rationalization, and minimization. Response C reflects understanding of the disease as a lifelong struggle.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-4, Common Coping Styles of Substance Abusers; page 279

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

5. ANS: B

Blackouts are gaps in memory that are symptomatic of advanced alcoholism.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol; Early Signs of Serious Problems With Alcohol; page 264

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

6. ANS: A

Marijuana is a cannabinol. It is not a narcotic or an amphetamine.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 271

KEY: Integrated Processes: Analysis | Content Area: Adolescent: Substance abuse | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Chemical and other dependencies

7. ANS: C

Disulfiram (Antabuse) is used to treat alcoholism by producing severe adverse effects in the presence of alcohol. Responses A and D are antipsychotics, and response B is an antianxiety medication used to treat alcohol withdrawal.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Pharmacology Corner for Alcohol; page 269

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse: Adult health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions

8. ANS: C

This response supports a safe environment for this patient, the other patients, visitors, and staff. Ignoring him will escalate the situation. Because his judgment is impaired, trying to reason with him will be unsuccessful.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems with substance abuse: Symptoms and nursing interventions; page 280

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse: Mental health: Therapeutic nursing process | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

9. ANS: B

This response shows that the wife is covering for her husband so he doesnt have to take responsibility for his actions. Response D is more denial. Responses A and C are indications of facing the reality of this situation.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; page 280

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Family dynamics, chemical and other dependencies

10. ANS: B

Supporting problem solving and helping her express herself is most important. Response A is advice giving, which is not appropriate. You dont have enough information to know if response C or D is correct.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; page 280

KEY: Integrated Processes: Nursing Process: Analysis/implementation | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication; chemical and other dependencies

11. ANS: B

Withdrawal symptoms in a heavy drinker generally begin within 24 to 48 hours after the last drink, although they can occur as early as 8 hours after the last drink.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Withdrawal; page 267

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Reduction of risk potential: Potential for alterations in body systems

12. ANS: C

This is the healthiest response that she is not accepting a victim role. In response A she continues to accept his bad behavior. In response B she is taking responsibility for his drinking, which is codependent. Response D views the meetings as escape rather than a place to work on issues.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; page 280

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Chemical and other dependencies: Coping mechanisms

13. ANS: A

These are classic symptoms along with irritability, rhinorrhea, and chills.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 273

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Chemical and other dependencies

14. ANS: A

Response A is an open-ended statement to help him identify his feelings and encourage further exploration. Response B asks for him to understand why he feels this way and he may not know. Responses C and D reinforce denial.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems with substance abuse: Symptoms and nursing interventions; page 280

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

15. ANS: C

Blackouts are indications of advanced alcoholism when the person has no memory of recent events.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol; page 265

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Physiological adaptation: Illness management

16. ANS: D

Taking personal responsibility for the misuse of alcohol and the distress it has caused others is key to beginning recovery. It is the basis of Alcoholics Anonymous. Blaming others for ones problem may be an initial coping mechanism.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-1, The Twelve Steps and Twelve Traditions of Alcoholics Anonymous; page 268

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

17. ANS: C

Response C is reality based and avoids any enabling behavior that reinforce/support her drinking. The other responses are enabling.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; pagae 280

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

18. ANS: B

Withdrawal symptoms also include insomnia and lethargy.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 271

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Chemical and other dependencies

19. ANS: A

Hallucinogenics like LSD produce a sense of enhanced perception of the environment, which can contribute to a sense of depersonalization and panic.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 272

KEY: Integrated Processes: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Chemical and other dependencies

20. ANS: B

Though the initial reaction may be more like a stimulant, it is a CNS depressant.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol; page 264

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Chemical and other dependencies

21. ANS: D

Tactile hallucinations are false perceptions of the sense of touch that often are described as something crawling on or under ones skin. Tactile hallucinations can occur as part of delirium tremens from long-term alcohol use and withdrawal.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Alcohol; Alcohol Withdrawal; page 267 | Chapter 15: Schizophrenia Spectrum and other psychotic disorders; Table 15-3 Recognized Hallucinations; page 234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Chemical and other dependencies and Physiological Integrity: Physiological adaptation: Medical emergencies

22. ANS: B

This response asks the patient to focus on reality rather than blaming others. This is the best response to challenge the probable denial.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; page 280-1

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

23. ANS: C

This response indicates the patient understands his or her personal responsibility to stay sober. The other responses show a lack of understanding that alcoholism is a lifelong disorder and that it is not caused by family problems.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-5, Problems With Substance Abuse: Symptoms and Nursing Interventions; page 280

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Chemical and other dependencies

24. ANS: A

Rohypnal along with Ecstasy create disinhibition and amnesia.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Table 17-3, Comparing Commonly Abused Substances; page 275

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Chemical and other dependencies

COMPLETION

25. ANS:

Alcoholics Anonymous

Alcoholics Anonymous is the most accepted support group widely available throughout the world.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Treatment of Alcoholism; page 267

KEY: Integrated Processes: Teaching/Learning | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Chemical and other dependencies

MULTIPLE RESPONSE

26. ANS: A, C

Dual diagnosis, also known as co-occurring disorder, is very common in people with psychiatric disorders who self-medicate for uncomfortable symptoms.

PTS: 1 REF: Chapter 17: Substance Use and Addictive Disorders; Introduction; page 262

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders and substance abuse | Cognitive Level: Application | Client Need: Psychosocial Integrity: Coping mechanisms and Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

27. ANS: C, D, F

One of the strengths of this program is its anonymity, so last names are never used and meetings are closed. Admitting powerlessness over the substance abused is key to making progress.

PTS: 1

REF: Chapter 17: Substance Use and Addictive Disorders; Treatment of Alcoholism; page 267-268

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

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