Chapter 47: Care of Patients with Substance Abuse Disorders My Nursing Test Banks

Chapter 47: Care of Patients with Substance Abuse Disorders

MULTIPLE CHOICE

1. The alcoholic patient says to the nurse, I am not an alcoholic. I can quit any time I want to. The nurse recognizes the defense mechanism of:

a.

repression.

b.

denial.

c.

rationalization.

d.

intellectualization.

ANS: B

Denial is ignoring reality in spite of hard evidence. Denial is a mechanism frequently used by substance abusers. Repression refers to unconsciously blocking an unwanted thought or memory from open expression. Rationalization attempts to justify a behavior or action by making an excuse or an explanation. Intellectualization is the excessive reasoning and logic to counter emotional distress.

DIF: Cognitive Level: Application REF: 1066 OBJ: 4 (theory)

TOP: Alcoholism: Defense Mechanism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

2. The wife of an alcoholic tells the nurse, My husband only drinks on the weekends to relax. He has a very stressful job. The nurse recognizes the defense mechanism of:

a.

repression.

b.

denial.

c.

rationalization.

d.

identification.

ANS: C

Rationalization is a justification for an unreasonable act to make it appear reasonable. Rationalization is used by many families to allay their own anxiety about the substance abuse of a family member. Repression refers to unconsciously blocking an unwanted thought or memory from open expression. Denial is ignoring reality in spite of hard evidence. Denial is a mechanism frequently used by substance abusers. Identification refers to modeling behaviors after another individual.

DIF: Cognitive Level: Application REF: 1066 OBJ: 5 (theory)

TOP: Family Reaction to Substance Abuse: Rationalization

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

3. The nurse explains the difference between an enabler and a co-dependent is that a co-dependent:

a.

covers up the behavior of the substance abuser.

b.

rationalizes the behavior of the substance abuser.

c.

uses the behavior of the substance abuser to build up his or her own self-esteem.

d.

is also a substance abuser.

ANS: A

The co-dependent fixes things by overcompensating to prevent the abuser from facing reality. Enabling refers to helping a person so that the persons consequences from unhealthy behavior are less severe; thus enabling helps the unhealthy behavior to continue.

DIF: Cognitive Level: Application REF: 1067-1068 OBJ: 5 (theory)

TOP: Co-dependent vs. Enabler KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

4. The nurse explains that, no matter whether you drink a 12-ounce beer, a 6-ounce glass of wine, or 1.5 ounces of straight liquor, it takes approximately _____ minutes for the body to metabolize it.

a.

20

b.

30

c.

40

d.

60

ANS: D

The metabolization of any amount of alcohol takes approximately 1 hour.

DIF: Cognitive Level: Comprehension REF: 1068 OBJ: 3 (theory)

TOP: Alcohol: Metabolization Time KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A person in jail for public intoxication has been without alcohol for 12 hours. The jail nurse would be alert for withdrawal signs of:

a.

irritability.

b.

nausea and vomiting.

c.

hallucinations.

d.

seizures.

ANS: A

Marked irritability is the early sign (6 to 12 hours after last drink) of alcohol withdrawal.

DIF: Cognitive Level: Comprehension REF: 1068 OBJ: 6 (theory)

TOP: Alcohol Withdrawal: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. A patient who is still intoxicated has been admitted for detoxification at the treatment center. The nurse takes into consideration that the patient will be supported in his withdrawal with the use of:

a.

psychotherapy support only.

b.

heavy doses of opioids to keep the patient sedated for 72 hours.

c.

symptomatic relief until substance has cleared from his system.

d.

titrated amounts of alcohol until severe withdrawal is over.

ANS: C

The alcoholic in withdrawal is supported with symptomatic relief for nausea and vomiting, cramps, and possible seizure.

DIF: Cognitive Level: Comprehension REF: 1068 OBJ: 6 (theory)

TOP: Alcoholism: Detoxification KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. After detoxification from substance abuse, the patient says, I feel better than I have in years! All I needed was some rest. I am not an alcoholic. The nurse should respond to this by saying:

a.

What were you doing that got you admitted to the detoxification center?

b.

Alcoholism has many definitions. What is yours?

c.

Admitting to alcoholism is hard.

d.

Alcoholism has ruined your life. How can you say you are not an alcoholic?

ANS: A

Confronting denial and encouraging self-diagnosis is the point of the treatment phase after detoxification. Asking for the patients definition of alcoholism allows for the patient to intellectualize the problem. Stating that alcoholism is hard is a sympathetic and unhelpful response. Alcoholism has ruined your life is accusatory and counterproductive.

DIF: Cognitive Level: Analysis REF: 1069 OBJ: 6 (theory)

TOP: Alcoholism: Post-detoxification KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

8. The nurse explains that an alternative to disulfiram (Antabuse) is the drug naltrexone (ReVia), which can:

a.

cause severe headaches if alcohol is consumed while using the drug.

b.

cause a dependence on ReVia rather than on alcohol.

c.

release endorphin-like enzymes that mimic intoxication.

d.

block craving and prevent relapse.

ANS: D

Naltrexone (ReVia) can be used to block the craving for alcohol and to prevent relapse in the recovery phase.

DIF: Cognitive Level: Comprehension REF: 1069 OBJ: 6 (theory)

TOP: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The nurse encourages the recovering alcoholic to participate in group therapy because of the major and long-lasting benefit of:

a.

development of improved social skills.

b.

progression toward sobriety.

c.

provision of a sense of belonging.

d.

increasing self-discipline.

ANS: D

The learning of the skill of self-discipline is the long-lasting benefit from group therapy. The other options are also benefits, but the major one is self-discipline, a skill a drug abuser must acquire for successful rehabilitation.

DIF: Cognitive Level: Analysis REF: 1069 OBJ: 1 (clinical)

TOP: Group Therapy: Benefits KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

10. The nurse is aware that when Korsakoffs syndrome is suspected from behavioral cues, the syndrome can be confirmed by:

a.

liver biopsy.

b.

brain scan.

c.

magnetic resonance imaging.

d.

spinal tap.

ANS: B

The individual with Korsakoffs syndrome has grossly impaired memory and gait disturbance. Confabulation (making up stories) frequently is seen as an attempt to communicate. A brain scan will show brain atrophy; currently there is no treatment to reverse the condition.

DIF: Cognitive Level: Comprehension REF: 1071 OBJ: 3 (theory)

TOP: Korsakoffs Syndrome: Diagnosis KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. The nurse uses the CAGE challenge to alcoholics who persist in denial. The G in the set of questions from CAGE stands for:

a.

Do you feel like you must get alcohol?

b.

Do you go out to drink?

c.

Is memory of drinking episodes gone?

d.

Do you feel guilty about your drinking?

ANS: D

A commonly used screening tool for alcohol abuse is the CAGE assessment. Two or more yes answers has a 90% correlation with an alcohol abuse problem. The G stands as a reminder for the question, Do you feelguilty about your drinking?

DIF: Cognitive Level: Comprehension REF: 1076-1077 OBJ: 3 (theory)

TOP: CAGE Queries: Significance KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

12. The nurse is aware that the newly admitted patient who overdosed on lorazepam (Ativan) will show signs of withdrawal in _____ hours.

a.

8

b.

24

c.

36

d.

72

ANS: D

Because of the long half-life of benzodiazepines, the withdrawal from them is delayed for up to 3 to 5 days.

DIF: Cognitive Level: Application REF: 1072 OBJ: 3 (theory)

TOP: Benzodiazepine: Withdrawal KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse is concerned about a coworker who exhibits a sign of amphetamine abuse, such as:

a.

excited speech.

b.

attention to detail.

c.

sluggish, slurred speech.

d.

eating sweets constantly.

ANS: A

Excited speech, euphoric behavior, increased alertness, and anorexia are indications of abuse of amphetamines.

DIF: Cognitive Level: Application REF: 1074 OBJ: 3 (theory)

TOP: Amphetamine Abuse: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

14. The nurse is aware that many people who abuse Cannabis (marijuana) rationalize their use because of the drugs ability to:

a.

sedate them.

b.

expand their senses.

c.

heighten sexual pleasure.

d.

be obtained legally for therapeutic purposes.

ANS: B

Many young people offer the increased sensitivity to sound, colors, and other environmental elements as a rationale for using the nonaddicting drug.

DIF: Cognitive Level: Analysis REF: 1075 OBJ: 3 (theory)

TOP: Cannabis: Rationalization for Use KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

15. When a patient is admitted after abusing a hallucinogenic substance, the care plan must be altered to include interventions for:

a.

dangerously elevated blood pressure.

b.

deep coma-like sleep.

c.

cardiac arrhythmias.

d.

provision of safety to reduce injury.

ANS: D

People under the influence of hallucinogenic drugs cannot separate fact from fantasy and have a distortion of senses. They can do unpredictable and dangerous things that can bring them to harm because of their impaired judgment.

DIF: Cognitive Level: Application REF: 1076 OBJ: 3 (theory)

TOP: Hallucinogen Abuse: Precautions KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. To better ensure successful rehabilitation from substance abuse, it is essential that the patient, family, and medical professional:

a.

collaborate on goals for treatment.

b.

be alert to relapse.

c.

agree that all drugs and paraphernalia be discarded.

d.

support commitment to a 12-step program.

ANS: A

Collaboration is basic for success of rehabilitation. The patient and family must be part of the decision-making process for the formulation of treatment goals.

DIF: Cognitive Level: Analysis REF: 1081 OBJ: 5 (theory)

TOP: Treatment: Goals KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. The nurse is aware that before nurses can be effective in dealing with substance abusers, nurses must:

a.

be familiar with self-help programs.

b.

examine their own bias relative to substance abuse.

c.

be knowledgeable about theories of addiction.

d.

be consistent.

ANS: B

Nurses must be aware of their own biases and attitude toward substance abuse and substance abusers before they can relate effectively with the patient. While consistency is important to the interaction, it is most important for nurses to have an awareness of their own personal positions on the matter.

DIF: Cognitive Level: Analysis REF: 1078 OBJ: 3 (theory)

TOP: Nurses Bias: Evaluation KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

18. A patient who has been given naloxone (Narcan) for an overdose of opiates is rapidly recovering from the effect of his heroin overdose when suddenly he relapses and his level of consciousness and respirations decrease. The nurse should:

a.

inform the charge nurse.

b.

repeat the Narcan.

c.

start CPR.

d.

ambulate the patient.

ANS: B

Narcan has a short half-life, and opiate action may resume and cause respiratory depression. Narcan may be repeated, or the nurse can request a continuous IV infusion of the drug.

DIF: Cognitive Level: Application REF: 1070 OBJ: 3 (theory)

TOP: Narcan: Short Half-life KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

19. The nurse is caring for an undernourished alcoholic patient. The nurse is helping the patient to select items from the menu. The patients diet should ideally:

a.

consist of at least 30% protein.

b.

limit fat and cholesterol.

c.

be limited to 2 g of sodium.

d.

contain at least 50% carbohydrates.

ANS: D

The diet for the malnourished alcoholic patient should be high in protein and consist of at least 50% carbohydrates. There are no specific limitations for fat and cholesterol.

DIF: Cognitive Level: Comprehension REF: 1081 OBJ: 3 (theory)

TOP: Nursing Care Plan 47-1: Care of the Patient with a Substance Abuse Disorder

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

20. The nurse is caring for a patient who is undergoing detoxification from alcohol. Which supplement can the nurse expect to be included in the prescribed medications?

a.

Potassium chloride supplements

b.

Thiamine

c.

Riboflavin

d.

Folic acid

ANS: B

The treatment for the alcoholic undergoing detoxification includes the administration of large doses of thiamine (vitamin B1). Thiamine acts as a nerve insulator in the body and is absent in the diets of most chronic alcoholics.

DIF: Cognitive Level: Comprehension REF: 1081 OBJ: 3 (theory)

TOP: Alcoholism: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

21. The nurse is caring for a patient who has a heightened risk for seizures during his alcohol detoxification. Which medication may be included in the patients care?

a.

Magnesium sulfate

b.

Chlordiazepoxide (Valium)

c.

Promethazine (Phenergan)

d.

Dicyclomine (Bentyl)

ANS: A

The person undergoing alcohol withdrawal is at risk for the development of seizures. Magnesium sulfate may be prescribed to prevent their onset. Chlordiazepoxide may be administered to reduce anxiety. Promethazine (Phenergan) and dicyclomine (Bentyl) may be used to reduce symptoms such as nausea and vomiting.

DIF: Cognitive Level: Application REF: 1069 OBJ: 6 (theory)

TOP: Alcoholism: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

22. The nurse lists the diagnostic criteria for the diagnosis of substance abuse, which are: (Select all that apply.)

a.

failure to meet obligations (school, work, relationships).

b.

putting self and others in potential harm (speeding, recklessness).

c.

conflict with law enforcement authorities.

d.

physical debilitation.

e.

denying substance abuse.

ANS: A, B, C

Physical debilitation and denial are not in the criteria established by the American Psychiatric Association for the diagnosis of substance abuse.

DIF: Cognitive Level: Comprehension REF: 1068 OBJ: 2 (theory)

TOP: Substance Abuse: Diagnostic Criteria

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

23. The nurse reviews the criteria for the diagnosis of alcohol dependency, which include: (Select all that apply.)

a.

identifiable withdrawal signs and symptoms.

b.

decreasing tolerance.

c.

altered family relationships.

d.

blackouts or amnesia pertinent to drinking episodes.

e.

altered occupational productivity.

ANS: A, C, D, E

All options except decreasing tolerance are part of the diagnostic guidelines for the diagnosis of alcohol dependency. Increasing tolerance would be part of the diagnostic criteria.

DIF: Cognitive Level: Comprehension REF: 1068 OBJ: 3 (theory)

TOP: Alcohol Dependence: Diagnostic Criteria

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

24. The nurse cautions the recovering alcoholic who is on disulfiram (Antabuse) that even the smallest exposure to alcohol can cause: (Select all that apply.)

a.

chest pain.

b.

nausea and vomiting.

c.

hypertension.

d.

blurred vision.

e.

blinding headache.

ANS: A, B, D

Disulfiram (Antabuse) is a drug that causes unpleasant reactions if the patient decides to return to drinking anytime within 2 weeks after starting Antabuse. Even small quantities of alcohol that might be inhaled from shaving lotion could trigger serious reactions such as chest pain, nausea and vomiting, hypotension, weakness, blurred vision, and confusion.

DIF: Cognitive Level: Comprehension REF: 1069 OBJ: 6 (theory)

TOP: Antabuse: Effect KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. The nurse assesses indications that the recovering alcoholic may be developing Wernickes encephalopathy when the nurse observes: (Select all that apply.)

a.

confusion.

b.

hallucinations.

c.

verbally aggressive behavior.

d.

ataxia.

e.

seizures.

ANS: A, D

A serious effect of chronic alcohol abuse is damage to brain cells. A condition that is reversible with treatment is Wernickes encephalopathy. This condition precedes Korsakoffs syndrome (substance-induced persisting dementia), which is irreversible. If the individual has a history of alcohol use and displays the symptoms of confusion, ataxia, and significant memory loss, Wernickes encephalopathy is suspected. Verbal aggression, hallucinations, and seizures are not characteristic of Wernickes encephalopathy.

DIF: Cognitive Level: Comprehension REF: 1071 OBJ: 3 (theory)

TOP: Wernickes Encephalopathy: Signs and Symptoms

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

26. The nurse encourages a substance abuser to join a support group because the purpose of a support group is to: (Select all that apply.)

a.

provide healthy relationships.

b.

offer opportunity to practice new coping skills.

c.

decrease stress and anxiety.

d.

improve social skills.

e.

provide opportunity for catharsis.

ANS: A, B, C, D, E

All options are benefits of support groups.

DIF: Cognitive Level: Application REF: 1073 OBJ: 1 (clinical)

TOP: Support Groups: Purpose KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

27. The nurse is aware that users of inhalants and hallucinogens are a danger to themselves and others because these drugs cause: (Select all that apply.)

a.

distortion of senses.

b.

impaired sense of time.

c.

uncontrolled flashbacks.

d.

panic.

e.

severely impaired judgment.

ANS: A, B, C, D, E

Hallucinogens cause distortion of the senses, an inability to separate fact from fantasy, impaired sense of time, and severely impaired judgment. Users never know whether they will have a good trip or a bad one. Uncontrolled flashbacks (feelings and sensations associated with use despite being drug-free) can occur. This group of drugs is very dangerous because use is known to cause panic, paranoia, and death from extremely impaired judgment.

DIF: Cognitive Level: Comprehension REF: 1076 OBJ: 3 (theory)

TOP: Hallucinogens: Effects KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

28. The nurse reminds a family that the decision to become substance free is difficult because it involves commitment to: (Select all that apply.)

a.

a lifestyle change.

b.

new coping skills.

c.

honesty in communication.

d.

awareness of possible periods of relapse.

e.

completing the program in 12 months.

ANS: A, B, C, D

The limitation of 12 months is not part of the commitment. Rehabilitation may take several years or a lifetime.

DIF: Cognitive Level: Analysis REF: 1078 OBJ: 3 (clinical)

TOP: Rehabilitation: Skills KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

MATCHING

The nurse clarifies terms relative to substance abuse. Match the option with the definition.

a.

Abuse

b.

Psychological dependence

c.

Addiction

d.

Tolerance

e.

Withdrawal

29. Needs substance to prevent symptoms of withdrawal

30. Symptomatology related to cessation of drug

31. Needs substance to feel good

32. Uses psychoactive drugs in nontherapeutic manner

33. Needs increasing amounts of substance to achieve desired effect

29. ANS: C DIF: Cognitive Level: Knowledge REF: 1067

OBJ: 2 (theory) TOP: Terms: Definition KEY: Nursing Process Step: NA

MSC: NCLEX: NA

30. ANS: E DIF: Cognitive Level: Knowledge REF: 1066

OBJ: 2 (theory) TOP: Terms: Definition KEY: Nursing Process Step: NA

MSC: NCLEX: NA

31. ANS: B DIF: Cognitive Level: Knowledge REF: 1066

OBJ: 2 (theory) TOP: Terms: Definition KEY: Nursing Process Step: NA

MSC: NCLEX: NA

32. ANS: A DIF: Cognitive Level: Knowledge REF: 1066

OBJ: 2 (theory) TOP: Terms: Definition KEY: Nursing Process Step: NA

MSC: NCLEX: NA

33. ANS: D DIF: Cognitive Level: Knowledge REF: 1066

OBJ: 2 (theory) TOP: Terms: Definition KEY: Nursing Process Step: NA

MSC: NCLEX: NA

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