Chapter 35: Care of the Patient with an Addictive Personality My Nursing Test Banks

Chapter 35: Care of the Patient with an Addictive Personality

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.A 60-year-old man was admitted for cholecystitis that resulted in a cholecystectomy. On his third day of hospitalization, he begins to sweat profusely, tremble, and has a blood pressure of 160/100. Based on these findings, what focused assessment should the nurse complete?

a. Cardiac problems
b. Respiratory problems
c. Withdrawal problems
d. Circulatory problems

ANS: C

Diaphoresis, tremors, and hypertension are all symptoms of withdrawal from alcohol consumption. The nurse, concerned about the patients medical condition, may not consider substance abuse until withdrawal symptoms appear.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1148

OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2.What age of onset of alcohol consumption is most predictive of alcohol addiction?

a. 8 or younger
b. 10 or younger
c. 12 or younger
d. 14 or younger

ANS: D

Forty-four percent of those who start drinking at the age of 14 or younger will develop alcoholism.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1145

OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3.Alcohol is involved in motor vehicle accidents, suicides, and homicides. Approximately how many deaths each year are related to alcohol consumption?

a. 50,000
b. 70,000
c. 80,000
d. 100,000

ANS: D

About 100,000 deaths each year are related to alcohol consumption.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1146

OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

4.What stage of dependence is described by a patient when he tells the nurse that he has tried to stop his drug habit, but he does not feel normal without it?

a. Early
b. Prodromal
c. Middle
d. Late

ANS: C

In the middle stage, the user shows signs of withdrawal with abstinence and must use the drug to feel normal.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1147

OBJ: 2 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

5.What must a patient in the late stages of dependence do in order to recover?

a. Gain insight into the addiction
b. Receive treatment for substance abuse
c. Pledge to lead a completely different lifestyle
d. Seek a nondrug-oriented support system

ANS: B

Very few people in the late stage of dependence will recover without treatment. The other options may aid in the recovery, but it is the treatment that is essential for recovery.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1147

OBJ: 2 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

6.What is the best response by a nurse when a patient inquires how alcohol acts so quickly on his system?

a. Alcohol is digested quickly.
b. Alcohol is converted to glycogen immediately.
c. Alcohol is metabolized into ethanol rapidly.
d. Alcohol is excreted in urine slowly.

ANS: C

Alcohol is not digested or converted into glycogen, but it is metabolized quickly by the liver to ethanol.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1148

OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7.The nurse reminds a group of high school students that most states have laws limiting blood alcohol levels of drivers. What is the legal blood alcohol serum level in most states?

a. 0.08%
b. 0.20%
c. 0.40%
d. 0.50%

ANS: A

Most states designate blood alcohol serum levels of 0.08% as the legal limit for driving a motor vehicle.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148

OBJ: 3 TOP: Alcoholism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8.A pregnant adolescent tells the nurse that she only drinks a little. How many drinks per day can cause an adverse effect in an infant?

a. One drink a day
b. Two drinks a day
c. Three drinks a day
d. Four drinks a day

ANS: B

As few as two drinks per day may cause adverse effects in an infant.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148

OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9.The nurse assesses an alcoholic patient carefully for signs of withdrawal. How soon after cessation of alcohol intake do withdrawal symptoms usually appear?

a. 3 hours
b. 4 hours
c. 5 hours
d. 6 hours

ANS: D

Withdrawal signs can occur as early as 6 hours after cessation of alcohol intake and sometimes last for 3 to 5 days.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148

OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

10.The nurse is performing an initial assessment on an alcoholic patient. Which of the following actions by the nurse would best ensure honest answers?

a. Not asking personal questions
b. Having a nonjudgmental attitude
c. Including the family
d. Promising the patient not to tell anyone

ANS: B

Maintaining a nonjudgmental attitude may reassure the patient and allow him to be more honest in his responses to the admission assessment.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1149

OBJ: 5 TOP: Alcoholism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

11.During the detoxification period, what does the nurse aim to achieve when designing interventions?

a. Enroll the patient in Alcoholics Anonymous (AA)
b. Keep the patient safe from aspiration and seizure
c. Help the patient interact in nonaddictive activities
d. Help the patient gain insight into the addiction

ANS: B

Care for the addicted patient starts with detoxification and is focused on keeping the patient safe from the symptoms of withdrawal. Enrolling the patient in AA, helping the patient interact in nonaddictive activities, and helping the patient gain insight into the addiction would be part of the rehabilitation process.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1150

OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12.What should the entire health team focus on during the rehabilitation phase?

a. Establishing a support system
b. Seeking and maintaining employment
c. Abstaining from drug use
d. Addressing the problems related to addiction

ANS: C

The focus of rehabilitation is for the patient to abstain from drug use.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1151

OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

13.What should the nurse do to decrease the patients disorientation at night during the detoxification period?

a. Place the patient in a room with another recovering patient
b. Instruct the patient to orient himself to his surroundings at bedtime
c. Wake the patient up every 4 hours to eat a small snack
d. Use nightlights and remove extra furniture from the room

ANS: D

Use of nightlights and removing extra furniture that could be misidentified will reduce disorientation. The patient should not be woken up to eat, but if he is awake, small snacks can be offered. The nurse should orient the patient to his surroundings.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1150

OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

14.The nurse explains that Alcoholics Anonymous (AA) consists of abstinent alcoholics who help other alcoholics become and stay sober. What is the foundation of AA?

a. Psychotherapy
b. A 12-step program
c. Treatment center
d. Individual counseling

ANS: B

The foundation of AA is a 12-step program.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1152

OBJ: 5 TOP: Alcoholism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

15.What severe side effect will occur if an alcoholic patient consumes alcohol while taking disulfiram (Antabuse)?

a. Nausea
b. Blackouts
c. Headaches
d. Hypertension

ANS: A

When a person who is taking Antabuse consumes alcohol, severe nausea, tachycardia, shortness of breath, confusion, and dizziness are experienced. The drug is used as a form of aversion therapy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1151

OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16.If the patient tells the nurse, Im not an alcoholic. I can stop whenever I want to, what should be the nurses most therapeutic response?

a. Well, why dont you?
b. Hasnt alcohol use interfered with your employment?
c. A positive attitude like that is a good start.
d. What would you call alcoholism?

ANS: B

When the addicted person presents in denial, the nurse should use techniques to set limits on that behavior.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1150

OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

17.When a patient denies any problems related to addiction, what is the nurses most therapeutic response?

a. What do you call this hospitalization?
b. How can anybody help you if you dont see a problem?
c. Would your family agree that you have no problems?
d. Can you think of any time your behavior created an unpleasant situation in your life?

ANS: D

When the patient denies that his behavior is problematic, the nurse should ask the patient to recount incidences when the behavior had unpleasant consequences.

PTS:1DIF:Cognitive Level: Analysis

REF: Page 1151, Nursing Care Plan 35-1 OBJ: 1

TOP:AddictionKEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

18.Which drug is often used in date rape?

a. Dalmane
b. Xanax
c. Narcan
d. Rohypnol

ANS: D

Rohypnol has been abused as a date-rape drug and has not been approved for use in the United States.

PTS: 1 DIF: Cognitive Level: Comprehension| Cognitive Level: Knowledge

REFage 1154OBJ:6TOP:Addiction

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

19.A patient seems bewildered when he confides in the nurse that all of his friends and leisure time have been centered on a drug culture. Which would be the best response by the nurse?

a. What other sort of activities might you enjoy?
b. You will need to get new friends.
c. Returning to those activities will get you back here and in trouble.
d. You need to get a hobby.

ANS: A

Encouraging the patient to imagine new activities is a start toward seeking them. Giving advice is not therapeutic.

PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1151-1152

OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

20.When a patient is admitted with an overdose of an opioid narcotic, the nurse should anticipate an order for which drug to reverse the effects of the narcotic?

a. Clonidine
b. Narcan
c. Orlaam
d. Methadone

ANS: B

Opioid overdose treatment involves administering Narcan as prescribed to reverse the effects of the narcotic.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1155

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

21.The nurse concludes that a significant goal of the care plan for an alcoholic patient has been met when the patient makes which statement?

a. I drink because Im lonely.
b. All my difficulties are related to my drinking.
c. I wouldnt need to drink if I had my family back.
d. My drinking helps me cope with the stress of my job.

ANS: B

A major goal for the successful treatment of alcoholics is to have them express responsibility for their behavior.

PTS:1DIF:Cognitive Level: Application

REF: Page 1151, Nursing Care Plan 35-1 OBJ: 5

TOP:AddictionKEY:Nursing Process Step: Evaluation

MSC: NCLEX: Psychosocial Integrity

22.While creating a methadone protocol for a patient rehabilitating from heroin addiction, the nurse explains that the patient will take methadone for what length of time?

a. Daily for the rest of his life
b. Daily until stabilized, then gradually reduce the dose to zero
c. Weekly for at least 6 months, then decrease the dose to once a month
d. Monthly for 6 to 10 months, then decrease the dose to zero

ANS: B

Methadone is given daily until the patient is stabilized. The methadone is reduced gradually until the patient does not need to take any.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1155

OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

23.A 22-year-old patient presents in the emergency department with the characteristics of severe Parkinson disease. The nurse should suspect an overdose of what drug?

a. Marijuana
b. Cocaine
c. Amphetamines
d. Valium

ANS: C

Over time, dopamine depletion in the brain can cause Parkinson-like symptoms to occur in people who abuse amphetamines.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

24.A college student has brought his hallucinating roommate to the college clinic. The young man says his roommate has been experimenting with phencyclidine (PCP). How long should the nurse expect the hallucinations to last?

a. 30 to 60 minutes
b. 1 to 4 hours
c. 4 to 6 hours
d. 6 to 12 hours

ANS: D

Some hallucinogenic effects of PCP can last 6 to 12 hours.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

25.The mother of a young woman being treated for amphetamine overdose asks the nurse when the manifestations will subside. What would be the most correct answer by the nurse?

a. Usually in 8 to 10 hours.
b. She will snap out of it in a day or two.
c. Usually in about 2 hours, but the effects will return in 2 to 3 days.
d. The manifestations may be permanent.

ANS: D

The manifestations of overdose of amphetamines are frequently permanent.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

26.What nursing intervention should be included in the plan of care for a baby born to a drug-addicted mother?

a. Swaddle the baby closely
b. Place the baby in a brightly lit area
c. Hold and rock the baby frequently
d. Place the baby in a busy part of the nursery for stimulation

ANS: A

A baby born to a drug-addicted mother should be swaddled, placed in an area of low stimulation, and minimally handled.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1156

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

27.What is the greatest problem with lysergic acid diethylamide (LSD) use?

a. The drug is addictive.
b. The drug stimulates drug-seeking behavior.
c. The drug causes flashbacks.
d. The drug sets off hypertensive episodes.

ANS: C

LSD causes flashbacks, or bad trips, unpredictably, and the flashbacks may occur years after ingestion of the drug. LSD is not considered an addictive drug and does not stimulate drug-seeking behavior. Hypertension is not a typical side effect of LSD.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1156

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

28.What should the nurse do to decrease the damage of bruxism seen in a patient who has been abusing the drug ecstasy?

a. Turn the patient to his right side
b. Elevate the head of the bed 30 degrees
c. Provide the patient with a pacifier
d. Administer a muscle relaxant

ANS: C

The use of an infant pacifier will reduce the damage to the teeth for a patient who is manifesting bruxism (grinding of the teeth).

PTS: 1 DIF: Cognitive Level: Application REF: Page 1157

OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

29.What should the nurse do when suspecting a co-worker of abusing drugs while at work?

a. Confront the abuser
b. Report observations to a supervisor
c. Call the state board of nursing
d. Discuss the problem with another co-worker

ANS: B

The nurses observations should be reported objectively, preferably in writing, to the supervisor.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1161

OBJ:7TOP:Impaired nurse

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

30.Which statement describes the impaired nurse who is in a peer assistance program?

a. The nurse has a revoked nursing license.
b. The nurse does not have to notify her employer.
c. The nurse will be allowed to work as a nurse under supervision.
d. The nurse will be reported to the Healthcare Integrity and Protection Data Bank.

ANS: C

The peer assistance program allows the nurse to retain licensure and continue to work under supervision, although possibly in an area where access to controlled drugs is difficult. It is necessary for the employer to have information regarding the peer assistance assignment. Action is not reported to the Healthcare Integrity and Protection Data Bank until final adverse actions are taken, allowing the nurse to complete the peer assistance program.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1161

OBJ: 7 TOP: Impaired nurse KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

MULTIPLE RESPONSE

31.During the initial intake assessment of a drug user, the nurse should attempt to obtain which subjective data? (Select all that apply.)

a. Usual pattern of use
b. Specific drug
c. Previous arrests
d. Amount of drug used
e. Time of last use

ANS: A, B, D, E

Determining the drug, strength, frequency, last use, and pattern of use is the basic database on a substance abuser.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1149

OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

32.The nurse should assess a patient for which criteria of addiction? (Select all that apply.)

a. Excessive use of the substance
b. Increase in social function
c. Uncontrollable consumption
d. Increase in economic function
e. Psychological disturbances

ANS: A, C, E

Criteria for addiction include excessive use of the substance, a decrease in social function, uncontrollable consumption, a decrease in economic function, and psychological disturbances.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1146

OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

33.A nurse suspects her a co-worker is abusing drugs. Which of the following symptoms, noticed in the co-worker, would contribute to the suspicions?

a. Spending more time with co-workers
b. Frequently absent from the unit
c. Rapid changes in mood and performance
d. Increased somatic complaints
e. Patients report they did not receive their medications

ANS: B, C, D, E

Signs of drug abuse in a nurse include the nurse becoming more isolated from co-workers, being frequently absent from the unit, rapidly changing mood and performance, increasing somatic complaints, and patients reporting they did not receive their medications.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1146

OBJ:7TOP:Mental illness

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

COMPLETION

34.When assessing an alcoholic patient, the nurse notes short-term memory loss, painful extremities, footdrop, and muttered incoherent responses to questions. The nurse recognizes these symptoms as most likely related to a condition caused by long-term alcohol abuse, which is known as __________ syndrome.

ANS:

Korsakoff

Korsakoff syndrome is a permanent condition caused by long-term alcohol use. The patient mutters incoherently and experiences short-term memory loss, painful extremities, and footdrop.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148

OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

35.The nurse uses the CAGE questionnaire to assess a patient. The nurse suspects the patient is an alcoholic if there are affirmative answers for _____ items on the questionnaire.

ANS:

2

two

An affirmative answer on two or more questions on the CAGE questionnaire is reason to assess more closely for possible alcohol abuse.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1149

OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

36.The nurse cautions that a person who chronically abuses drugs may experience mental impairment. The area of the brain that can be affected and permanently damaged is the ________ _________.

ANS:

limbic system

The most commonly abused drugs act on the limbic system of the brain and can cause permanent damage.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1153

OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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