Chapter 49: Substance Abuse My Nursing Test Banks

Chapter 49: Substance Abuse

Test Bank

MULTIPLE CHOICE

1. A 16-year-old male has been referred to the community mental health center following legal charges of driving under the influence. Which screening tests would be appropriate to use on this patient?

a.

Drug Abuse Screening Test (DAST)

b.

Adolescent Alcohol Involvement Scale (AAIS)

c.

Adolescent Drug Abuse Diagnosis (ADAD)

d.

Minnesota Multiphasic Personality Inventory (MMPI 2)

ANS: B

The adolescent patient has legal problems associated with alcohol use. The AAIS screening instrument would be appropriate to use. DAST is a comprehensive screening and assessment instrument. ADAD is an adolescent drug abuse diagnosis instrument. MMPI is a personality inventory.

DIF: Cognitive Level: Comprehension REF: p. 834 OBJ: N/A

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

2. A patient admitted 48 hours ago has a diagnosis of gastrointestinal (GI) bleeding and is receiving IV hydration and transfusions. When making rounds, the nurse observes the patient to be having a tonic clonic seizure. What may be the cause of the seizure?

a.

Low blood counts as a result of bleeding

b.

Alcohol withdrawal

c.

Alkalosis

d.

Inadequate nutrition

ANS: B

Alcohol withdrawal symptoms can begin within a few hours of discontinuation of drinking and may continue for 3 to 10 days. Withdrawal symptoms may be severe and include visual and auditory hallucinations and tonic clonic seizures. The patients admitting diagnosis, GI bleeding, may be associated with alcohol abuse. Denial is a common symptom associated with alcoholism, and the patient may not have been honest about alcohol intake when the health care provider took the history on admission. History may be obtained from the patients family or significant other. It is unlikely that the blood loss is significant enough to induce seizures. Alkalosis is not likely the cause of seizures in this case; the patient is more likely to be acidotic from the combined dehydration and withdrawal. Common causes in the setting of alcohol withdrawal include alcoholic ketoacidosis and ingestion of alcohols or medications that result in metabolic acidosis (e.g., methanol, ethylene glycol, salicylate). Inadequate nutrition is not likely to cause seizures in this patient.

DIF: Cognitive Level: Application REF: p. 837 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

3. Which theory views addiction as a maladaptive habit that can be examined and changed the same way as other habits?

a.

Psychoanalytic theory

b.

Behavior theory

c.

Cognitive theory

d.

Family system theory

ANS: B

Behavior or learning theories view addictive behaviors as overlearned maladaptive habits that can be examined and changed in the same way as other habits. Psychoanalytic theory bases substance abuse on fixation with oral issues. Cognitive theories suggest that addiction is based on a distorted way of thinking about substance use. Family system theory emphasizes the pattern of relationships among family members through the generations as an explanation of substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 829 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

4. A nurse working the night shift suspects that a colleague is abusing alcohol. Which action by the nurse is most important?

a.

Good faith reporting is unfaithful to a colleague.

b.

Reporting will result in loss of the colleagues license.

c.

It is not of concern, and the nurse wont be penalized for refusing to get involved.

d.

State guidelines may mandate to report substance abuse.

ANS: D

In some states, when substance abuse of a colleague is suspected, reporting is mandatory. Professionals must be loyal to their patients and protect them from harm. Good faith reporting should not be viewed as disloyalty to a colleague. Licenses are often not revoked when a colleague self reports or is reported for substance abuse. Health professionals may be named in a civil lawsuit if they fail to report suspected impairment of another professional.

DIF: Cognitive Level: Analysis REF: pp. 834-835 OBJ: 3

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

5. What does a urinalysis that is positive for the drug tested indicate?

a.

It indicates illegal drug use.

b.

It verifies drug dependency.

c.

It is a violation of the individuals constitutional rights.

d.

It verifies whether the drug is present in the specimen.

ANS: D

Positive urinalysis simply indicates the presence of the drug being tested for in the urine specimen. The person may have a prescription for a substance found in the urine or may have been accidentally dosed with it. Presence of the substance in the urine does not indicate dependence because the person may only be an episodic user of the substance. Asking for the persons permission to collect a specimen and examine it does not violate the persons constitutional rights. The Supreme Court has ruled that drug screening does not violate ones constitutional right to privacy or represent an unreasonable search.

DIF: Cognitive Level: Comprehension REF: p. 835 OBJ: N/A

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

6. What will the nurse instruct patients who are on daily disulfiram (Antabuse) to avoid?

a.

All forms of cough syrup

b.

Alcohol

c.

Benzodiazepines

d.

Aspirin products

ANS: B

Disulfiram is used to reduce the desire for alcohol by inducing severe nausea and vomiting when a patient ingests alcohol while on this drug. Reactions can be quite severe, and patients must understand the need to avoid all forms of alcohol while taking this medication. Not all cough syrups contain alcohol. Benzodiazepines and aspirin do not react with disulfiram.

DIF: Cognitive Level: Comprehension REF: pp. 847-848 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which protects individuals who have been successfully rehabilitated from substance abuse from discrimination related to past addiction?

a.

Americans with Disabilities Act (ADA)

b.

National Council on Alcoholism and Drug Dependence

c.

Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)

d.

American Medical Association (AMA)

ANS: A

Persons dependent on drugs, but who are no longer using drugs illegally and are receiving treatment for chemical dependence, or who have been rehabilitated successfully, are protected by the ADA from discrimination on the basis of past drug addiction. The National Council on Alcoholism and Drug Dependence is a voluntary health agency dedicated to educating the public about alcoholism. The ATF is a principal law enforcement agency in the U.S. Department of Justice dedicated to preventing terrorism, reducing violent crime, and protecting the United States. The AMA is a professional organization for physicians.

DIF: Cognitive Level: Comprehension REF: p. 835 OBJ: 1

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

8. What must be administered before glucose infusions for a patient in alcohol withdrawal to prevent Wernickes encephalopathy?

a.

Chlordiazepoxide (Librium)

b.

Thiamine

c.

Diazepam (Valium)

d.

Bromocriptine (Parlodel)

ANS: B

Thiamine and multiple vitamins should be administered routinely to patients in alcohol withdrawal. Intravenous fluid therapy for rehydration may be necessary, but thiamine must be administered before glucose infusion to prevent Wernickes encephalopathy. Benzodiazepines are given for treatment of anxiety and seizures associated with alcohol withdrawal. Bromocriptine is not used to prevent Wernickes encephalopathy.

DIF: Cognitive Level: Comprehension REF: p. 837 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. What effect will occur if a patient being treated with naltrexone (ReVia) for substance abuse ingests opioids or alcohol?

a.

Increased euphoria

b.

Nausea, vomiting, and diarrhea

c.

Deep sedation

d.

An absence of the high associated with drugs

ANS: D

Naltrexone is an opioid antagonist prescribed to block the pharmacologic effects of the high associated with opioids and alcohol. Studies report less alcohol craving and fewer drinking days, especially when naltrexone is combined with psychosocial treatment. Naltrexone prevents the euphoria associated with taking drugs like opioids and alcohol. These are symptoms of taking alcohol in combination with disulfiram (Antabuse). Naltrexone is not sedating.

DIF: Cognitive Level: Comprehension REF: p. 838 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. A patient is admitted into a substance abuse treatment center and is withdrawing from alcohol. Which statement made by the patients family member shows a need for further education?

a.

Withdrawal symptoms can begin within a few hours of discontinuation of drinking.

b.

Withdrawal symptoms will improve within 24 hours.

c.

Less than 1% of patients develop delirium tremens.

d.

Benzodiazepines are commonly used for detoxification.

ANS: B

Withdrawal symptoms may continue for 3 to 10 days. Withdrawal symptoms can begin within a few hours of discontinuation of drinking. Less than 1% of patients develop delirium tremens. Benzodiazepines are commonly used for detoxification.

DIF: Cognitive Level: Analysis REF: p. 837 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse is assisting with the development of care plan for a patient withdrawing from cocaine. What would be the first nursing diagnosis priority for this patient?

a.

Altered nutrition; less than body requirements

b.

Risk for altered peripheral tissue perfusion

c.

Risk for fluid volume deficit

d.

High risk for self directed violence

ANS: D

Depression with suicidal ideation is generally the most serious problem associated with cocaine withdrawal. Altered nutrition, risk for altered peripheral tissue perfusion, and risk for fluid volume deficit are not the priorities for a patient withdrawing from cocaine.

DIF: Cognitive Level: Analysis REF: p. 841 OBJ: 5

TOP: Nursing Process Step: Diagnosis

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

12. The nurse is transcribing an order for disulfiram on a patient in alcohol rehabilitation. When planning the time of day to administer this medication the nurse will document that disulfiram be given:

a.

before breakfast.

b.

with lunch.

c.

before dinner.

d.

at bedtime.

ANS: D

Disulfiram should be administered at bedtime to avoid the complications of sedative effects.

DIF: Cognitive Level: Application REF: pp. 847-848 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

13. Which patient assessment will the nurse expect to observe when a patient has ingested alcohol while on disulfiram (Antabuse)?

a.

Unconsciousness

b.

Hypertension

c.

GI bleeding

d.

Severe vomiting

ANS: D

Severe vomiting occurs when alcohol is ingested while a patient is on disulfiram therapy. Disulfiram blocks the metabolism of acetaldehyde, a metabolite of alcohol. Elevated levels of acetaldehyde produce a reaction causing nausea, severe vomiting, sweating, throbbing headache, dizziness, blurred vision, and confusion. Disulfiram will not generally cause unconsciousness when alcohol is ingested with it, does not cause hypertension when taken in combination with alcohol, and does not cause GI bleeding.

DIF: Cognitive Level: Application REF: p. 847 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

14. What is the rationale for administering acamprosate (Campral)?

a.

Withdrawal from alcohol addiction

b.

Maintenance of sobriety

c.

Improvement of renal function

d.

Correction of electrolyte imbalances

ANS: B

Acamprosate is used in alcohol rehabilitation programs for chronic alcoholics who want to maintain sobriety. Drugs likely to be given during withdrawal from alcohol addiction include anticonvulsants, thiamine, benzodiazepines, and beta blockers. Acamprosate does not improve renal function. Acamprosate does not correct electrolyte imbalances.

DIF: Cognitive Level: Comprehension REF: pp. 846-847 OBJ: N/A

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

15. What important point(s) of patient education should be included about disulfiram (Antabuse) therapy? (Select all that apply.)

a.

The patient should return for liver function tests in 10 to 14 days following initiation of therapy.

b.

Headache, fatigue, and a metallic taste are common adverse effects that usually resolve.

c.

Avoid alcohol ingestion to prevent a reaction.

d.

Carefully read all labels for possible alcohol content, including perfumes, and over the counter (OTC) medications such as cough syrups.

e.

Report to the health care provider any allergic symptoms, such as hives or pruritus.

ANS: A, B, C, D

Baseline laboratory data include liver function tests and alcohol screening. Headache, fatigue, and a metallic taste are common adverse effects of disulfiram. Disulfiram is a drug used to treat chronic alcoholism that produces a very unpleasant reaction to alcohol. Patients should be instructed to read all labels of topical substances and OTC drugs for alcohol content, as well as avoiding any foods that may be prepared with alcohol. Disulfiram is unlikely to cause allergic reactions.

DIF: Cognitive Level: Application REF: pp. 847-848 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. What does the biologic model theory of substance abuse hypothesize? (Select all that apply.)

a.

A predisposition to substance abuse based on a hereditary condition

b.

Alcoholic individuals as fixated at the oral stage of development, needing satisfaction through oral behaviors such as drinking

c.

Genetic aberrations that block feelings of well being, resulting in anxiety, anger, low self esteem, and other negative feelings, leaving a craving for a substance that will suppress the bad feelings

d.

That genes may play a role in alteration of metabolic enzyme systems in the body that enhance or detract from pleasurable responses to chemical substances

e.

That it is a persons choice of whether to use drugs, which drugs to use, how much to use, and to seek treatment for substance abuse

ANS: A, C, D

The biologic model hypothesizes that substance abuse is caused by a persons genetic profile, making a predisposition to substance abuse a hereditary condition. Genes may play a role in altering metabolic enzyme systems in the body that enhance or detract from pleasurable responses to chemical substances. Psychoanalytic theories see alcoholics as fixated at the oral stage of development. Sociocultural factors play a role in a persons choice of whether to use drugs, which drugs to use, how much to use, and treatment for substance abuse.

DIF: Cognitive Level: Comprehension REF: p. 829 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

17. A health professional colleague is suspected of having a substance abuse problem because of the persons frequent absenteeism, mood swings when at work, diminished alertness, and poor patient care. Which action(s) will the nurse take? (Select all that apply.)

a.

Confront the individual.

b.

Document specific examples of inappropriate actions.

c.

Avoid assigning this individual to patients with narcotic medication orders or high acuities.

d.

Notify law enforcement of the suspicions.

e.

Submit a confidential report to an appropriate supervisor.

ANS: B, E

Observation and documentation are crucial to building a record of repeat instances over time to support the suspicion of impairment. Examples of inappropriate actions need to be well documented over time. An accurate record can also be useful in helping the impaired individual to recognize the problems and submit voluntarily to treatment. If a health professional suspects that a colleague is impaired, a confidential report should be made to an appropriate supervisor familiar with institutional policy. Confronting the individual, avoiding assigning this individual to patients with narcotic medication orders or high acuities, and notifying law enforcement of the suspicions are not appropriate actions to take.

DIF: Cognitive Level: Application REF: pp. 833-835 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

18. A patient has completed substance abuse treatment for alcoholism. What will assist in long-term goal attainment and promote abstinence? (Select all that apply.)

a.

Naltrexone therapy

b.

Regular attendance at NA

c.

Regular contact with his program sponsor

d.

Following the 12 step program of AA

e.

Diazepam therapy to reduce the likelihood of DTs

ANS: A, C, D

Treatment may require pharmacologic treatment, such as disulfiram or naltrexone therapy. Regular contact with a sponsor provides support and continuity in the process of maintaining sobriety. Treatment requires lifelong effort with a combination of psychosocial support; use of the 12-step program will assist the patient in maintaining recovery. NA stands for Narcotics Anonymous; this patient should attend meetings of AA, or Alcoholics Anonymous. Diazepam has a high potential for abuse and should not be used with recovering addicts.

DIF: Cognitive Level: Application REF: p. 839 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

19. Which psychological trait(s) is/are linked to substance abuse? (Select all that apply.)

a.

Dependent personality

b.

Ability to relax

c.

Depression

d.

Anxiety

e.

Autonomy

f.

Social personality

g.

Optimism

ANS: A, C, D

Substance abuse has been linked to a dependent personality, depression, and anxiety.

Stress is one reason given for substance abuse. Antisocial personality is linked with substance abuse. Substance abusers tend to be depressed and pessimistic.

DIF: Cognitive Level: Comprehension REF: p. 829 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

20. Clonidine (Catapres) is used in treating which opioid withdrawal symptom(s)? (Select all that apply.)

a.

Hypertension

b.

Tremors

c.

Agitation

d.

Depression

e.

Sweating

f.

Nausea

ANS: B, C, E

Clonidine is useful in decreasing tremors, agitation, and sweating associated with opioid withdrawal. Clonidine does not have a hypotensive effect, treat depression, or alleviate nausea.

DIF: Cognitive Level: Comprehension REF: p. 839 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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