Chapter 57: Substance–Related and Addictive Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A patient has been diagnosed with alcoholism. A nurse tells him that he has a physical illness
with a genetic predisposition to alcoholism, and the only effective treatment is total abstinence
from alcohol. This type of approach characterizes which theory?
a.
Biologic
b.
Behavioral
c.
Sociocultural
d.
Intrapersonal
2. A nurse explains that according to the intrapersonal theory, addiction is caused by early
childhood rejection. These substance abusers are thought to have common characteristics.
What do these characteristics include?
a.
Open-boundary approach to life that likes to party frequently
b.
Attention seeking, need for control, and self-centeredness
c.
Shyness and anxiety
d.
Stress and eagerness to be a part of the in-group
3. During the taking of a medical history, a patient who is addicted to heroin reports he only uses
the drug a few times a week. What is the nurse’s best response when trying to disclose more
precise information?
a.
“OK. You only use heroin two times a week?”
b.
“What do you mean when you say ‘a few?’”
c.
“Are you saying that in a week’s time would you use heroin only two times?”
d.
“Rate your weekly usage on a scale of 1 to 15.”
4. A patient who is has alcoholism with a history of heavy drinking is brought to the inpatient
psychiatric unit saying that he does not know where he is or what day it is. What should the
nurse suspect he is exhibiting?
a.
Delirium
b.
Alcoholic dementia
c.
Blackout
d.
Amnesia
5. A nurse is discharging a patient with a pulmonary disorder to return home with her family.
She has had a difficult time while in the hospital and has experienced withdrawal from
tobacco. When the nurse tells her that community resources are available to help her to stop
smoking, she says, “That’s OK. I can stop whenever I want to.” What does this exemplify?
a.
Rationalization
b.
Denial
c.
Intellectualization
d.
Projection
6. A patient with an alcohol addiction says, “My drinking is all my wife’s fault. She makes me
so crazy I just have to have a drink.” What does this exemplify?
a.
Rationalization
b.
Denial
c.
Intellectualization
d.
Projection
7. Which information about a patient should lead a nurse to suspect substance abuse?
a.
Abnormal liver function test result and a gastrointestinal (GI) bleed
b.
Positive syphilis screening result and varicose veins
c.
Fungal infection and a potassium level of 4.2. mEq/L
d.
Decreased albumin level and creatinine level of 1.2 mg/dL
8. A urine drug screen is ordered for a patient suspected of a driving while intoxicated (DWI).
What drugs are included in this screening?
a.
Lysergic acid diethylamide (LSD), Valium, and Percocet
b.
Crack, heroin, and nonsteroidal antiinflammatory drugs (NSAIDs)
c.
Marijuana, amphetamines, and Elavil
d.
Librium, cocaine, and Zoloft
9. An alcoholic is brought into the emergency department in an intoxicated state at 2000. The
day shift nurse assesses the patient to exhibit tremors, have increased blood pressure, and
agitation at 0800 rounds. What do these signs and symptoms indicate?
a.
Major withdrawal
b.
Early withdrawal
c.
Delirium tremens
d.
Minor withdrawal
10. Which syndrome of alcoholism is related to thiamine deficiency?
a.
Fetal alcohol syndrome
b.
Wernicke encephalopathy
c.
Korsakoff psychosis
d.
Alcoholic dementia
11. A wife of a man with long-term alcoholism wants to help her husband quit drinking. The
nurse tells her that an initial approach might be for a group of friends and family to confront
the patient with his alcoholism. What should this group be prepared to indicate during this
confrontation?
a.
He needs help; his drinking is out of hand.
b.
They are fed up with him and will no longer be his friend.
c.
They reject his drinking but think he is a valuable person.
d.
He is still their friend even if he does not stop drinking.
12. A nurse recommends to an alcoholic that he join Alcoholics Anonymous. What is true about
this organization?
a.
Based on a 12-step approach with a strong religious base
b.
A social group of ex-drinkers who befriend one another in the process of
maintaining sobriety
c.
A religious support group that assists alcoholics during rehabilitation
d.
An anonymous group of sponsors who offer help to alcoholics
13. What should be avoided to prevent the accidental activation of Antabuse?
a.
Aged cheese
b.
Pickled foods
c.
Mouthwash
d.
Chocolate candy
14. A nurse in the admissions unit is informed that a patient is being brought in who has been
using “ice.” What should the nurse assess?
a.
Extreme dehydration
b.
Coma
c.
Dangerous hypertension
d.
Violent behavior
15. An LPN is assisting with the development of a nursing care plan for a patient who has been
using cocaine for 5 years. What should the nurse consider will most commonly need to be
dealt with in this patient?
a.
Depression
b.
Violent behavior
c.
Nasal erosion
d.
Suicide attempts
16. What might the positive effects of marijuana be used to treat?
a.
Diet control in morbidly obese patients
b.
Chemotherapy-induced nausea and vomiting
c.
Air hunger in patients with end-stage emphysema
d.
Early diabetic-induced cataracts
17. A nurse is counseling a pregnant cocaine abuser. What should the nurse inform this patient
that she is placing her baby at significant risk for?
a.
Severe allergies
b.
Neurologic impairments
c.
Hearing impairment
d.
Higher birth weights
18. What is the rationale for using methadone in the treatment of heroin abuse?
a.
Substitutes one opioid for another
b.
Is less constipating than heroin
c.
Does not give the “rush” that a person addicted to heroin is looking for
d.
Is a synthetic opioid, which makes it less addicting
19. Narcan has been given to a person with respiratory depression who is addicted to heroin.
What should the nurse be alert for indications of?
a.
Acute withdrawal symptoms
b.
Respiratory arrest
c.
Hypotensive crisis
d.
Cardiac arrest
20. Two treatment plans for abusers of alcohol and drugs are similar—90 meetings in 90 days and
12-step programs. What is the major difference in the success of the two types of programs?
a.
One program uses a 12-step approach, and the other program has a religious base.
b.
Heroin addicts have a higher success rate.
c.
Alcohol abusers have an easier time staying with the program.
d.
Relapse rates for patients using drugs other than alcohol alone are much higher.
21. Which nursing diagnosis is appropriate for a patient with substance abuse?
a.
Anxiety
b.
Chronic or situational low self-esteem
c.
Risk for delayed development
d.
Acute confusion
22. Which implementation can be used to help prevent relapse in a patient who has a substance
abuse problem?
a.
Self-hypnosis
b.
Imagery
c.
Stress management
d.
Blocking
23. In some cases, patients will use drugs or alcohol to treat the disturbing symptoms of a
psychiatric disease. What can occur in this scenario?
a.
A mixed-drug reaction, which may heighten the effects of both drugs
b.
Decreased psychiatric symptoms, which makes the psychiatric condition harder to
treat
c.
An accidental overdose by mixing alcohol with anxiolytic medications,
antipsychotic medications, or antidepressant agents
d.
An increase in psychiatric symptoms because the psychiatric drugs become less
effective in the presence of alcohol
MULTIPLE RESPONSE
24. A nurse indicates that a urine sample is needed for screening in a case of DWI. What actions
should be implemented? (Select all that apply.)
a.
Collection and witnessing by a staff member of the same gender
b.
Documented with a chain-of-custody form signed by all who handle the specimen
c.
Keep specimen under secure conditions if temporary storage is necessary
d.
Never be out of sight until someone from law enforcement takes it
e.
Place in a specially marked container
25. A nurse documents signs of Wernicke encephalopathy in a patient with long-term alcoholism.
What do these signs include? (Select all that apply.)
a.
Confabulation
b.
Ataxia
c.
Delirium
d.
Decreasing level of consciousness
e.
Projectile vomiting
26. What does alcohol abuse in the older adult place him or her at risk for? (Select all that apply.)
a.
Falls
b.
Malnutrition
c.
Respiratory infections
d.
Bone demineralization
e.
Cirrhosis
27. What is true regarding hair analysis done on an alcoholic? (Select all that apply.)
a.
Requires sensitive technology
b.
Is not reliable on treated or dyed hair
c.
Can determine addiction
d.
Can be informative in the treatment of a short-term abuser
e.
Can assess relapse
28. What factors make the adolescent extremely vulnerable to substance abuse (Select all that
apply.)
a.
Egocentricity
b.
Ability to use good judgment
c.
Poor impulse control
d.
Awareness of possible consequences
e.
Desire for peer identification
COMPLETION
29. A nurse explains that a test that can detect substance abuse for up to 1 year after only 2 or 3
days of use is performed on _____.
30. A nurse explains that because the drug disulfiram (Antabuse) is deemed inappropriate, the
patient has been put on the most reliable substitute, _____, which causes similar but less
severe side effects in the people with alcoholism who continue to drink.