Substance-Related Disorders

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FeverRN
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23678
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Substance-Related Disorders
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2010-06-15 16:15:11
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substance related disorders med surg nclex nursing drugs
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Substance-Related Disorders
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  1. A patient has been diagnosed with alcoholism. The 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:

    A. biologic theory.
    B. sociocultural theory.
    C. intrapersonal theory.
    D. behavioral theory.
    A. This question requires the test taker to differentiate among the theories and approaches commonly used with patients who are addicted.
    (this multiple choice question has been scrambled)
  2. The nurse explains that according to the intrapersonal theory, addiction is caused by early childhood rejection. These substance abusers are thought to have common characteristics that include:

    A. an 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.
    B. The intrapersonal theory identifies the common personality traits of self-centeredness, need for control, and attention seeking as parts of the addictive personality.
    (this multiple choice question has been scrambled)
  3. To assess the amount of pain medication needed by the patient who has bone cancer, but who has also been using heroin, the best approach is to:

    A. openly question the patient about his daily heroin use.
    B. try to use nonopioid medications so that you do not interfere with his heroin needs.
    C. tell the patient that getting his pain under control will be difficult because he uses heroin.
    D. ask the pharmacist to help you compute the amount of pain medication that you think he will need.
    A. When trying to get a health history on a substance abuse patient, the best method is an open discussion of the drug use. The discussion should be open and nonjudgmental.
    (this multiple choice question has been scrambled)
  4. An alcoholic patient is brought to the inpatient psychiatric unit saying that he does not know where he is or what day it is. Because he has a heavy drinking history, you suspect that he is having:

    A. delirium.
    B. alcoholic dementia.
    C. blackout.
    D. amnesia.
    C. Blackouts are common with heavy drinking over time. The patient data support that the memory loss is associated with the alcohol use, and blackouts would be an expected outcome.
    (this multiple choice question has been scrambled)
  5. The nurse is discharging a pulmonary patient home with her family. She has had a difficult time while in the hospital and experienced withdrawal from tobacco. When the nurse tells her that there are community resources to help her to stop smoking, she says, “That’s OK; I can stop whenever I want to.” This is an example of:

    A. intellectualization.
    B. rationalization.
    C. denial.
    D. projection.
    C. Denial is a common defense mechanism used by substance abusers.
    (this multiple choice question has been scrambled)
  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.” This is an example of:

    A. denial.
    B. projection.
    C. rationalization.
    D. intellectualization.
    B. The patient in the scenario is projecting. He is blaming his wife for his drinking problem rather than accepting that the drinking is his problem.
    (this multiple choice question has been scrambled)
  7. Substance abuse might be suspected in a patient who has:

    A. a fungal infection and a potassium level of 4.2. mEq/L.
    B. abnormal liver function tests and a GI bleed.
    C. a positive syphilis screen and varicose veins.
    D. a decreased albumin level and creatinine level of 1.2 mg/dL.
    B. Abnormal liver function tests and a GI bleed indicate substance abuse.
    (this multiple choice question has been scrambled)
  8. A urine drug screen is ordered for a patient suspected of a DWI. The nurse explains that drugs that are being screened for can include:

    A. Librium, cocaine, and Zoloft.
    B. marijuana, amphetamines, and Elavil.
    C. lysergic acid diethylamide (LSD), Valium, and Percocet.
    D. crack, heroin, and nonsteroidal anti-inflammatory drugs (NSAIDs).
    C. Has the correct combination of an illicit drug, an anxiolytic, and an opioid.
    (this multiple choice question has been scrambled)
  9. When an alcoholic patient brought in 12 hours ago in an intoxicated state begins to exhibit tremors and increased blood pressure and is agitated, the nurse assesses that the patient is in:

    A. early withdrawal.
    B. major withdrawal.
    C. minor withdrawal.
    D. delirium tremens.
    A. The signs of early withdrawal from alcohol are agitation and elevated vital signs. These warning signs usually occur 6 to 12 hours after the last drink.
    (this multiple choice question has been scrambled)
  10. The nurse is aware that the alcoholic patient is at risk for a syndrome related to thiamine deficiency, which is:

    A. fetal alcohol syndrome.
    B. Korsakoff’s psychosis.
    C. Wernicke’s encephalopathy.
    D. alcoholic dementia.
    C. Wernicke’s encephalopathy is a vitamin B1 (thiamine) deficiency. If not treated with vitamin supplements, the condition can progress to a more serious form.
    (this multiple choice question has been scrambled)
  11. The wife of a long-term alcoholic 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 and tell him that:

    A. he is still their friend, even if he doesn’t stop drinking.
    B. they are fed up with him and will no longer be his friend.
    C. he needs help; his drinking is out of hand.
    D. they reject his drinking but think he is a valuable person.
    D. The implementation for encouraging an alcoholic to go into treatment consists of a group of people telling the alcoholic that they think his drinking is destructive but they do not reject him as a person.
    (this multiple choice question has been scrambled)
  12. The nurse recommends to an alcoholic that he join Alcoholics Anonymous because this organization is:

    A. a social group of ex-drinkers who befriend the alcoholic in the process of maintaining sobriety.
    B. based on a 12-step approach with a strong religious base.
    C. a religious support group that assists alcoholics during rehabilitation.
    D. an anonymous group of sponsors who offer help to alcoholics.
    B. Alcoholics Anonymous is a group of people who come together to offer support to each other to stay sober. It has a religious base, recognizes a higher power, and uses a 12-step approach to sobriety.
    (this multiple choice question has been scrambled)
  13. The nurse cautions a patient who is taking disulfiram (Antabuse) that ____ should be avoided.

    A. Aged cheese
    B. Mouthwash
    C. Pickled foods
    D. Chocolate candy
    B. Mouthwash contains alcohol and can trigger the effect of an Antabuse reaction. The alcoholic taking Antabuse needs to be aware of the hidden alcohol in some commonly used mouthwashes and other over-the-counter drugs.
    (this multiple choice question has been scrambled)
  14. The nurse on the admission unit is informed that a patient is being brought in who has been using “ice.” The nurse is aware that this patient may be:

    A. violent.
    B. dangerously hypertensive.
    C. extremely dehydrated.
    D. in a coma.
    A. Persons who use “ice,” a form of methamphetamine, are frequently violent while under the influence. The effect of ice can last as long as 12 to 14 hours.
    (this multiple choice question has been scrambled)
  15. In assisting with the development of a nursing care plan for a patient who has been using cocaine for 5 years, the nurse will include provisions to deal with:

    A. suicidal attempt.
    B. violent behavior.
    C. nasal erosion.
    D. depression.
    D. Cocaine users can be depressed for as long as 2 years after quitting drug use. An antidepressant such as bupropion (Wellbutrin) is helpful in treating the depression.
    (this multiple choice question has been scrambled)
  16. Marijuana is a hallucinogenic that can be used for positive effects in the treatment of:

    A. early diabetic-induced cataracts.
    B. chemotherapy-induced nausea and vomiting.
    C. air hunger in end-stage emphysema patients
    D. diet control in the morbidly obese.
    B. Marijuana has been studied for use for nausea and vomiting in cancer patients. Marinol (dronabinol) is a marijuana derivative currently available for use with cancer patients.
    (this multiple choice question has been scrambled)
  17. The nurse counsels a pregnant cocaine abuser that her cocaine use put the baby at risk for:

    A. hearing impairment.
    B. higher birth weights.
    C. severe allergies.
    D. neurologic impairments.
    D. Babies born to mothers of cocaine addicts have a higher incidence of hyperactivity and neurologic problems.
    (this multiple choice question has been scrambled)
  18. Sometimes methadone is used in the treatment of heroin addiction. One reason that methadone is substituted for heroin is:

    A. methadone does not give the “rush” that heroin addicts are looking for.
    B. it is a synthetic opioid, which makes it less addicting.
    C. it is less constipating than heroin.
    D. it is a way to substitute one opioid for another.
    A. Methadone as an extended-release medication does not give the rush that addicts enjoy. It maintains the opioid level in the body but does so at a steady state and decreases cravings.
    (this multiple choice question has been scrambled)
  19. Narcan has been given to the heroin addict with respiratory depression. The nurse is alert for indications of:

    A. respiratory arrest.
    B. cardiac arrest.
    C. acute withdrawal symptoms.
    D. hypotensive crisis.
    C. Narcan is an opioid antagonist that causes the opioid to fall from receptor sites. When antagonist is given, the sudden loss of the opioid causes acute withdrawal to occur.
    (this multiple choice question has been scrambled)
  20. The treatment plans for alcohol abusers and drug abusers are similar—90 meetings in 90 days and 12-step programs. One difference is that:

    A. alcohol abusers have an easier time staying with the program.
    B. one program uses a 12-step approach and the other has a religious base.
    C. relapse rates for patients using drugs other than alcohol alone are much higher.
    D. heroin addicts have a higher success rate.
    C. One difference between alcohol and drug rehabilitation programs is that drug abusers will have a lower success rate. Alcohol abusers will have a higher rate of success when they follow the Alcoholics Anonymous program.
    (this multiple choice question has been scrambled)
  21. A nursing diagnosis that is appropriate for a patient with substance abuse is:

    A. Risk for delayed development.
    B. Chronic or situational low self-esteem.
    C. Acute confusion.
    D. Anxiety.
    B. Low self-esteem is related to loss of control and guilt.
    (this multiple choice question has been scrambled)
  22. An implementation that can be used to help prevent relapse in a patient who has a substance abuse problem is:

    A. self-hypnosis.
    B. blocking.
    C. stress management.
    D. imagery.
    C. Teaching these patients stress management will assist them in managing the conflict and stress in their daily lives that previously triggered substance abuse.
    (this multiple choice question has been scrambled)
  23. Older patients have a separate set of issues that affect their use of alcohol and other drugs. Some of these issues are all of the following except:

    A. drinking to cope with social isolation.
    B. using alcohol to relieve the stress of aging.
    C. a higher rate of alcoholism in retirement communities.
    D. peer pressure to drink more at social occasions.
    C. There is a higher rate of alcoholism in retirement communities because older adults are encouraged to drink at dinner and special occasions.
    (this multiple choice question has been scrambled)
  24. Substance abuse in adolescents can be a result of:

    A. wanting to feel part of their group and family dysfunction.
    B. family dysfunction and another family member who is using drugs.
    C. peer pressure and knowing who is dealing drugs.
    D. ineffective communication and denial.
    A. Peer pressure and wanting to feel part of the group are powerful motivators for adolescents. If the family is dysfunctional, there is added reinforcement to abuse drugs and frequent opportunities to abuse.
    (this multiple choice question has been scrambled)
  25. In some cases, patients will use drugs to treat the disturbing symptoms of psychiatric disease. This presents a problem, because there is the potential to:

    A. decrease psychiatric symptoms, which makes the condition harder to treat.
    B. cause an increase in psychiatric symptoms, because the psychiatric drugs become less effective in the presence of alcohol.
    C. cause a mixed drug reaction, which may have the effect of heightening both drug effects.
    D. cause an accidental overdose by mixing alcohol with anxiolytic medications, antipsychotic medications, or antidepressant agents.
    D. Combining alcohol and psychiatric drugs, anxiolytics, or antidepressants may cause an accidental overdose by increasing the central nervous system (CNS) effects.
    (this multiple choice question has been scrambled)
  26. The nurse clarifies that when a urine sample is needed for screening in a case of DWI or other crime, the specimen should (select all that apply):

    1. be collected and witnessed by a staff member of the same gender.
    2. be documented with a “chain of custody” form, signed by all who handle the specimen.
    3. be kept under secure conditions if temporary storage is necessary.
    4. never be out of sight until someone from law enforcement takes it.
    5. be placed in a specially marked container.
    • 1, 2, 3
    • The specimen, if placed in secure storage, does not have to be in sight nor does it need a specially marked container.
  27. The nurse documents signs of Wernicke’s encephalopathy in a patient with long-term alcoholism. These signs include (select all that apply):

    1. confabulation.
    2. ataxia.
    3. delirium.
    4. decreasing level of consciousness.
    5. projectile vomiting.
    • 1, 2, 3, 4
    • The signs of Wernicke’s encephalopathy do not include projectile vomiting.a
  28. The nurse explains that a test that can detect substance abuse for up to 1 year after only 2 or 3 days of use is done on ____________________.
    Hair
  29. The 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 alcoholic who continues to drink.
    Flagyl

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