Question 1

A nurse worked at a hospital for several months, resigned, and then took a position at another hospital. In the new position, the nurse often volunteers to be the medication nurse. After several serious medication errors, an investigation reveals that the nurse was diverting patient narcotics for self-use. What early indicator of the nurse's drug use was evident?

Accepted Answer

A)   Accepting responsibility for medication errors.
B)   Seeking to be assigned as a medication nurse.
C)   Frequent complaints of physical pain.
D)   High sociability with peers. B

Question 2

Which nursing diagnosis would likely apply both to a patient diagnosed with schizophrenia as well as a patient diagnosed with amphetamine-induced psychosis?

Accepted Answer

A)   Powerlessness
B)   Disturbed thought processes
C)   Ineffective thermoregulation
D)   Impaired oral mucous membrane B

Question 3

A new patient in an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and a few drinks in the evening." Which response by the nurse will help the patient view the drinking more honestly?

Accepted Answer

A)   "I see," and use interested silence.
B)   "I think you may be drinking more than you report."
C)   "Being a social drinker involves having a drink or two once or twice a week."
D)   "You describe drinking steadily throughout the day and evening. Am I correct?" D

Question 4

In the emergency department, a patient's vital signs are: blood pressure (BP), 66/40 mm Hg; pulse (P), 140 beats per minute (bpm); and respirations (R), 8 breaths per minute and shallow. The patient overdosed on illegally obtained hydromorphone (Dilaudid). Select the priority outcome.

Accepted Answer

A)   Within 8 hours, vital signs will stabilize as evidenced by BP greater than 90/60 mm Hg, P less than 100 bpm, and respirations at or above 12 breaths per minute.
B)   The patient will be able to describe a plan for home care and achieve a drug-free state before being released from the emergency department.
C)   The patient will attend daily meetings of Narcotics Anonymous within 1 week of beginning treatment.
D)   The patient will identify two community resources for the treatment of substance abuse by discharge.

Question 5

When assessing a patient who has ingested flunitrazepam (Rohypnol), the nurse would expect:

Accepted Answer

A)   acrophobia.
B)   hypothermia.
C)   hallucinations.
D)   anterograde amnesia.

Question 6

A patient has smoked two packs of cigarettes daily for many years. When the patient does not smoke or tries to cut back, anxiety, craving, poor concentration, and headache result. What does this scenario describe?

Accepted Answer

A)   Substance abuse
B)   Substance addiction
C)   Substance intoxication
D)   Recreational use of a social drug

Question 7

Which treatment approach is most appropriate for a patient with antisocial tendencies who has been treated several times for substance addiction but has relapsed?

Accepted Answer

A)   One-week detoxification program
B)   Long-term outpatient therapy
C)   Twelve-step self-help program
D)   Residential program

Question 8

A patient admitted to an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and several drinks during the evening." The patient is using which defense mechanism?

Accepted Answer

A)   Rationalization
B)   Introjection
C)   Projection
D)   Denial

Question 9

A patient in an alcohol treatment program says, "I have been a loser all my life. I'm so ashamed of what I have put my family through. Now, I'm not even sure I can succeed at staying sober." Which nursing diagnosis applies?

Accepted Answer

A)   Chronic low self-esteem
B)   Situational low self-esteem
C)   Disturbed personal identity
D)   Ineffective health maintenance

Question 10

Which question has the highest priority when assessing a newly admitted patient with a history of alcohol abuse?

Accepted Answer

A)   "Have you ever had blackouts?"
B)   "When did you have your last drink?"
C)   "Has drinking caused you any problems?"
D)   "When did you decide to seek treatment?"

Question 11

The treatment team plans care for a person diagnosed with schizophrenia and cannabis abuse. The person has recently used cannabis daily and is experiencing increased hallucinations and delusions. Which principle applies to care planning?

Accepted Answer

A)   Consider each disorder primary and provide simultaneous treatment.
B)   The person will benefit from treatment in a residential treatment facility.
C)   Withdraw the person from cannabis, and then treat the schizophrenia.
D)   Treat the schizophrenia first, and then establish the goals for the treatment of substance abuse.

Question 12

Which statement most accurately describes substance addiction?

Accepted Answer

A)   A chronic, relapsing brain disease associated with craving and a lack of control over use of a substance.
B)   A disorder associated with tolerance to a substance as well as withdrawal symptoms if use is abruptly discontinued.
C)   Behaviors associated with habitual use of a substance for the single purpose of altering one's mood, emotion, or state of consciousness.
D)   A behavioral disorder associated with selected personality features.

Question 13

A patient admitted for a heroin overdose received naloxone (Narcan). The patient's breathing pattern improved. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, "I feel terrible." Which analysis is correct?

Accepted Answer

A)   The patient is exhibiting a prodromal symptom of seizures.
B)   An idiosyncratic reaction to naloxone is occurring.
C)   Symptoms of opiate withdrawal are present.
D)   The patient is experiencing a relapse.

Question 14

A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled "lorazepam." What is the nurse's first action?

Accepted Answer

A)   Test reflexes
B)   Check pupils
C)   Initiate vomiting
D)   Establish a patent airway

Question 15

A patient admitted yesterday for injuries sustained in a fall while intoxicated believes snakes are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?

Accepted Answer

A)   Disturbed sensory perception
B)   Ineffective coping
C)   Ineffective denial
D)   Risk for injury

Question 16

When working with a patient beginning treatment for alcohol abuse, what is the nurse's most therapeutic approach?

Accepted Answer

A)   Empathetic, supportive
B)   Strong, confrontational
C)   Skeptical, guarded
D)   Cool, distant

Question 17

Which assessment findings support a nurse's suspicion that a patient has been using inhalants?

Accepted Answer

A)   Pinpoint pupils and respiratory rate of 12 breaths per minute
B)   Perforated nasal septum and hypertension
C)   Drowsiness, euphoria, and constipation
D)   Confusion, mouth ulcers, and ataxia

Question 18

While caring for a patient with a methamphetamine overdose, which tasks are the priorities of care? (Select all that apply.)

Accepted Answer

A)   Administration of naloxone (Narcan) 
B)   Vitamin B12 and folate supplements
C)   Restoring nutritional integrity
D)   Prevention of seizures
E)   Reduction of fever

Question 19

Which is an important nursing intervention when giving care to a patient withdrawing from a central nervous system (CNS) stimulant?

Accepted Answer

A)   Make physical contact by frequently touching the patient.
B)   Offer intellectual activities requiring concentration.
C)   Avoid manipulation by denying the patient's requests.
D)   Observe for depression and suicidal ideation.

Question 20

A nurse with a history of narcotic abuse is found unconscious in the hospital locker room after overdosing. The nurse is transferred to an inpatient substance abuse unit for care. Which attitudes or behaviors by nursing staff may be enabling?

Accepted Answer

A)   Conveying understanding that pressures associated with nursing practice underlie substance abuse.
B)   Pointing out that work problems are the result, but not the cause, of substance abuse.
C)   Conveying empathy when the nurse discusses fears of disciplinary action by the state board of nursing.
D)   Providing health teaching about stress management.

Exam 19: Substance-Related and Addictive Disorders