Chapter 23: Chemically Mediated Responses and Substance-Related Disorders My Nursing Test Banks

Chapter 23: Chemically Mediated Responses and Substance-Related Disorders

Test Bank

MULTIPLE CHOICE

1. An individual who is admitted to an alcohol detoxification unit has had no alcohol intake for 3 days. On admission the patient is noted to have tremors, anxiety, insomnia, and disorientation accompanied by tachycardia and diaphoresis. These signs and symptoms are characteristic of the syndrome known as:

a.

alcoholic hallucinosis.

b.

alcohol-induced psychosis.

c.

alcoholic seizure disorder.

d.

alcohol withdrawal delirium.

ANS: D

The signs and symptoms listed are consistent with alcohol withdrawal delirium. It usually has its onset 3 to 5 days after the last drink and lasts 2 to 3 days. It is considered a medical emergency.

DIF: Cognitive Level: Comprehension REF: Text Page: 454

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. The nursing intervention of highest priority relative to alcohol withdrawal delirium is:

a.

application of restraints.

b.

reorientation of the patient to reality.

c.

identification of existing social supports.

d.

maintenance of fluid and electrolyte balance.

ANS: D

Maintaining physiological stability is of highest priority. Withdrawal delirium is often accompanied by loss of fluid and electrolytes through vomiting, diarrhea, and diaphoresis.

DIF: Cognitive Level: Analysis REF: Text Page: 454

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. A patient asks a nurse, What is the primary aim of self-help groups for alcohol abusers? The nurse should reply, The goal is first to:

a.

always be available to help others with an addiction.

b.

commit to always strive for total abstinence.

c.

find and rely on the help of the members sponsor.

d.

admit powerlessness over the addiction.

ANS: B

Although all the options are expectations in the program, admitting to having alcoholism and staying alcohol-free are the aims of the Alcoholics Anonymous (AA) program.

DIF: Cognitive Level: Application REF: Text Page: 461

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. The spouse of a patient with alcoholism asks, How do I respond in a helpful way even though this abuse is so harmful to my family? The nurses best response would be:

a.

Search the house regularly for hidden alcohol.

b.

Include your spouse in family activities whether or not drinking has occurred.

c.

Make your spouse responsible for the consequences of the disruptive behavior.

d.

Refuse to be supportive when your spouse is under the influence of alcohol.

ANS: C

Dysfunctional families often try to protect the patient, avoid confrontation, and blame themselves. These are called enabling behaviors. Making the patient responsible for the consequences of drinking is difficult and usually requires professional support and/or involvement in Alcoholics Anonymous (AA).

DIF: Cognitive Level: Application REF: Text Page: 466

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. When designing a teaching plan for a patient taking disulfiram (Antabuse), a nurse should include an explanation on the importance of avoiding certain over-the-counter substances. With the appropriate instruction, which substance could the patient identify as being safe to use?

a.

Antacids

b.

Mouthwash

c.

Cough syrups

d.

Cold medications

ANS: A

Substances that may potentially contain alcohol must be avoided. The use of antacids would be safe.

DIF: Cognitive Level: Application REF: Text Page: 462

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A nurse has concerns about erratic behavior and slurred speech of another member of the nursing staff. The most appropriate action for the concerned nurse to take is to:

a.

immediately confront the impaired nurse with the observation.

b.

ask other nurses if they have observed anything unusual regarding the nurse in question.

c.

personally supervise the team member whenever the care involves the preparation of pain medication.

d.

notify the nursing supervisor to assess the team members condition and performance.

ANS: D

Impairment should be documented by more than one person. The impaired nurse then must be relieved of duty. Further intervention can be planned and implemented at a later time.

DIF: Cognitive Level: Application REF: Text Page: 437

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. The most positive initial action for a health care agency to take for an impaired nurse would be:

a.

job dismissal.

b.

eliciting a promise to abstain.

c.

counseling by the nurse manager.

d.

referral to the employee assistance program.

ANS: D

Most health care agencies have employee assistance programs. Counseling for substance abuse is better provided by professionals in a neutral setting than by peers or administrators in the clinical area.

DIF: Cognitive Level: Comprehension REF: Text Page: 468

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. When a recovering impaired colleague returns to work, nursing professionals can be most helpful by:

a.

directly offering support.

b.

double-checking all the nurses activities.

c.

assigning another nurse to watch the recovering nurse closely.

d.

avoiding mention of the problem unless the recovering nurse mentions it.

ANS: A

Direct offers of support are appropriate just as they are if a colleague is dealing with any other health problem. Avoiding mention is like trying to ignore an elephant in the room. Surreptitious observation and checking are demeaning.

DIF: Cognitive Level: Application REF: Text Page: 457

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. In the emergency room a nurse learns that a patient has recently taken a large amount of the drug PCP. The nurse should be ready to provide interventions for:

a.

acute psychosis, agitation, and violence.

b.

hypotension, sedation, and respiratory depression.

c.

heightened sensory perceptions, dizziness, and ataxia.

d.

paranoid thinking, hyperthermia, hyperactivity, and arrhythmias.

ANS: A

PCP ingestion often produces an acutely psychotic state in which the patient is markedly agitated. Violence toward self or others is common. Because the drug produces anesthesia, the patient may be unaware of pain.

DIF: Cognitive Level: Application REF: Text Page: 450

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. A patient has been admitted in an acute psychotic state after ingesting PCP. The nurse has not been able to administer the prescribed dose of benzodiazepine because of the patients aggressive behavior. The most appropriate intervention under these circumstances would be to:

a.

provide an alternative activity to channel energy.

b.

move the patient to a quiet room to minimize stimulation.

c.

perform a lavage to prevent continuing absorption of drug.

d.

assign a nurse to stay with the patient to reassure and calm the patient.

ANS: B

The safety of the patient and others is an important concern. Patients who have ingested PCP often display unprovoked violence and agitation. It is important that the benzodiazepine be administered as soon as the patient is taken to the seclusion room. The seclusion room provides an environment of minimal stimulation, essential to calming the patient.

DIF: Cognitive Level: Application REF: Text Page: 450

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. A novice nurse on the chemical dependence unit mentions, The drugs of abuse all seem to cause patients to become violent. The best reply would be:

a.

Violence is usually associated with abuse rather than with drug withdrawal.

b.

There are abused drugs, such as heroin, that rarely produce violent behavior.

c.

The observation is generally true since most abusers have observable antisocial tendencies.

d.

Ineffective nursing actions toward patients are more responsible for violence than drugs are.

ANS: B

Heroin, a CNS depressant, causes sedation. Opiate withdrawal produces flulike symptoms rather than acute psychosis.

DIF: Cognitive Level: Application REF: Text Page: 443

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A nurse should specifically assess a patient opiate withdrawal for:

a.

lacrimation, rhinorrhea, dilated pupils, and muscle pain.

b.

somnolence, constipation, normal pupils, and hypothermia.

c.

tremors, hypertension, constricted pupils, and deep sleep.

d.

visual and tactile hallucinations, agitation, and generalized seizures.

ANS: A

The classic signs of opiate withdrawal are flulike symptoms and dilated pupils.

DIF: Cognitive Level: Comprehension REF: Text Page: 443

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A patient sustained a fractured femur while driving under the influence of drugs. Family members indicate that the patient has dabbled in drugs for years. When the patient obtains little relief from the prescribed dose of narcotic analgesic, the nurse suspects the ineffective pain relief is related to:

a.

drug tolerance to the narcotic prescribed.

b.

the predictable onset of withdrawal symptoms.

c.

insufficient analgesic dosage to manage the pain.

d.

the strong likelihood of a history of substance abuse.

ANS: A

Tolerance to opiates develops when used repeatedly (i.e., a larger amount of the drug is needed to produce the desired effect). If the patient uses heroin or another opiate individually or in conjunction with other drugs, tolerance may be present. In addition, cross-tolerance develops among CNS depressants, meaning that as tolerance to one drug develops, tolerance develops to all other drugs in the group as well. Although withdrawal and insufficient analgesic medication dosage may result in pain, this patients assessment data and history are strong indicators of possible drug tolerance. A history of substance abuse would be a red flag regarding the possibility of withdrawal symptoms when the patient is no longer receiving any analgesic medications.

DIF: Cognitive Level: Analysis REF: Text Page: 448

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Adaptation: Pharmacological and Parenteral Therapies

14. An unconscious patient is brought to the emergency department. It is suspected the patient overdosed on heroin. What drug can the nurse anticipate will be administered?

a.

Disulfiram (Antabuse)

b.

Naltrexone (Revia)

c.

Methadone (Methadose)

d.

Acamprosate (Campral)

ANS: B

Naltrexone is an opiate antagonist. It will reverse CNS depression caused by opiates. Nalmefene is a newer opiate antagonist that may be ordered in lieu of naltrexone.

DIF: Cognitive Level: Application REF: Text Pages: 461-462

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Adaptation: Pharmacological and Parenteral Therapies

15. A nurse suspects that a patient being admitted for outpatient surgery may have a history of alcohol abuse. To further assess this issue, the nurse should consider:

a.

using a screening tool, such as AUDIT-C to assess the extent of the abuse.

b.

asking directly if the patient has ever had problems with abusing alcohol.

c.

interviewing the family because the patient is likely to deny having a problem.

d.

addressing the suspicion before discharge since it has no direct effect on the patients surgery.

ANS: A

Screening tools like AUDIT-C increase the accuracy of assessment. Exploring alcohol use before a surgical procedure is important, because excessive use may result in the patient experiencing withdrawal symptoms or other alcohol-related problems postoperatively.

DIF: Cognitive Level: Application REF: Text Page: 438

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. An appropriate short-term goal related to abstinence for a drug abuser would be The patient will:

a.

verbalize details of the addiction to significant others.

b.

declaratively state an intention to abstain from drug use of any sort.

c.

be able to identify the underlying causes that resulted in an addiction to drugs.

d.

contact a supportive person if experiencing an urge to use an addictive substance.

ANS: D

Patients often become anxious at the thought of never again using the substance to which they are addicted. Therefore it may be helpful to focus on short-term goals, such as using a supportive sponsor when the urge to use occurs. The remaining options reflect long-term goals.

DIF: Cognitive Level: Application REF: Text Pages: 456-457

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

17. A short-term goal for a patient in the early stage of therapy for addiction to sedatives and stimulants is, The patient will:

a.

verbalize dependence on drugs.

b.

discuss his or her addictive behavior with others.

c.

recognize the situations in which drugs are abused.

d.

understand the reasons the dependency on drugs developed.

ANS: A

Acknowledging the problem is an appropriate short-term goal. Discussing the addictive behavior with others may or may not be of initial value, while recognizing triggering situations and understanding the reasons that facilitated the addiction are intermediate to long-term goals.

DIF: Cognitive Level: Application REF: Text Pages: 456-457

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

18. Whenever possible, physical exercise and meditation should be a daily component of the ongoing program of treatment for a person with an addiction. The basis for these aspects of treatment is to make use of the bodys natural:

a.

endocrines.

b.

endorphins.

c.

enkephalins.

d.

epinephrine.

ANS: B

The release of endorphins occurs with strenuous exercise and meditation and results in a feeling of well-being and reduced cravings. The remaining options do not present with those results.

DIF: Cognitive Level: Comprehension REF: Text Page: 434

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

19. A patient addicted to both alcohol and benzodiazepines tells a nurse, I can control my drug use anytime I want to. This statement is an example of the patients use of:

a.

denial.

b.

repression.

c.

compensation.

d.

reaction formation.

ANS: A

Believing one can control drug use despite addiction is based in the coping mechanism of denial. Denial, rationalization, and minimization are coping mechanisms often used by patients who abuse drugs or alcohol.

DIF: Cognitive Level: Application REF: Text Page: 455

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. In assessing risks and planning interventions, a nurse should recognize that the longer the half-life of a drug of abuse, the:

a.

shorter the withdrawal.

b.

less intense the withdrawal symptoms.

c.

sooner the patient will begin to crave the drug.

d.

shorter the withdrawal and the more intense the symptoms.

ANS: B

The relevant guidelines are as follows: the longer the half-life of the drug, the longer the withdrawal symptoms will last, and the less intense the withdrawal symptoms will be.

DIF: Cognitive Level: Comprehension REF: Text Page: 453

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. Care planning for a patient undergoing detoxification for both alcohol and sedative-hypnotics is based on the treatment principle that states that:

a.

medications are used to treat symptoms as they appear.

b.

a cross-tolerant drug is used to gradually wean the patient.

c.

liver function is preserved best by avoiding detoxification drugs.

d.

forcing fluids is therapeutic since detoxification mainly occurs in the kidneys.

ANS: B

Withdrawal from alcohol, barbiturates, and benzodiazepines is similar. The goal is to prevent severe withdrawal symptoms by giving a drug with a similar action that is tapered down and eventually discontinued.

DIF: Cognitive Level: Comprehension REF: Text Pages: 441-442

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. A patient is brought to the emergency department to be assessed after an auto accident. The patient has slurred speech and ataxia and reacts aggressively when examined. The patients blood alcohol level (BAL) is 0.4 g/dl. From the relationship between the behavior and the BAL, the nurse can make the assessment that the patient:

a.

takes disulfiram (Antabuse).

b.

is experiencing alcohol poisoning.

c.

has ingested acamprosate (Campral).

d.

has a significantly high tolerance to alcohol.

ANS: D

A non-tolerant individual would be comatose with a BAL of 0.4 g/dl. The fact that the patient can walk and talk strongly suggests that the body has developed tolerance to alcohol.

DIF: Cognitive Level: Application REF: Text Page: 439

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. A nurse using cognitive behavioral therapy to treat a patient with substance abuse problems will:

a.

help the patient to develop self-control and social skills.

b.

support the use of emotion-focused coping mechanisms.

c.

focus on addiction as a disease requiring confrontational tactics.

d.

help the patient see that society shares responsibility for the problem.

ANS: A

Cognitive behavioral approaches are aimed at improving self-control and social skills to reduce substance use. Self-control strategies include goal setting, self-monitoring, analysis of drinking antecedents, and learning of alternative coping skills. Social-skills training focuses on learning skills for forming and maintaining interpersonal relationships, assertiveness, and drink refusal.

DIF: Cognitive Level: Application REF: Text Pages: 464-465

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

24. It will be most helpful for a nurse to describe a relapse to a recovering substance abuser as a(n):

a.

error from which to learn.

b.

indicator of treatment failure.

c.

event with a physiological cause.

d.

need for additional environmental support.

ANS: A

Abstinence and relapse should be viewed as a process rather than distinct events. Recovery is not an all-or-nothing proposition. Success can be measured by improvements, whereas relapse can be viewed as an error from which to learna temporary setback on the road to recovery.

DIF: Cognitive Level: Application REF: Text Page: 465

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25. A nursing diagnosis universally appropriate for patients who abuse mood-altering drugs would be:

a.

confusion.

b.

ineffective coping.

c.

imbalanced nutrition.

d.

impaired environmental interpretation syndrome.

ANS: B

Ineffective coping is a nursing diagnosis that could be used for a patient who abuses any of the mood-altering drugs. Other nursing diagnoses that have wide application to patients who abuse mood-altering drugs are disturbed sensory perception, disturbed thought processes, and disturbed family processes.

DIF: Cognitive Level: Comprehension REF: Text Page: 457

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Short-term goals related to substance abstinence include which of the following? (Select all that apply.)

a.

The patient will make a daily commitment to abstain.

b.

The patient will attend at least two support group meetings weekly.

c.

The patient will focus on improving the quality of the relationship with a significant other.

d.

The patient will call a supportive person when experiencing an urge to use an addictive substance.

e.

The patient will commit to provide support to others expressing an interest and need to abstain from addictive substances.

ANS: A, B, D, E

Initial short-term goals related to abstinence should focus on self. Relationships, job, education, and other issues should be deferred unless they are roadblocks to recovery since that will focus attention on the immediate problem.

DIF: Cognitive Level: Application REF: Text Pages: 456-457

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

2. The following are goals for a patient being treated for alcoholism. Select the order in which these goals should be approached.

A. Developing alternative coping skills

B. Attaining physiological stabilization

C. Learning about dependence and recovery

D. Abstinence and development of a support system

a.

A, B, C, D

b.

B, D, C, A

c.

C, D, B, A

d.

D, C, B, A

ANS: B

Physiological stabilization is basic to the success of other goals. When abstinence and a support system to promote abstinence have been developed, attention can be turned to learning about dependence and recovery and developing alternative coping skills.

DIF: Cognitive Level: Comprehension REF: Text Pages: 456-457

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

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