Chapter 19: Substance-Related and Addictive Disorders

Question 1

A patient with a history of daily alcohol abuse was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?

a. Between 0800 and 1000 today (6 to 8 hours after drinking stopped)
b. Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)
c. About 0200 on hospital day 3 (72 hours after drinking stopped)
d. About 0200 on hospital day 4 (96 hours after drinking stopped)

Answer 1

ANS: B

Alcohol withdrawal usually begins 6 to 8 hours after cessation or significant reduction of alcohol intake. It
peaks between 24 and 48 hours, then resolves or progresses to delirium.

Question 2

A woman in the last trimester of pregnancy drinks 8 to 12 ounces of alcohol daily. The nurse plans for the delivery of an infant who is:

a. jaundiced.
b. dependent on alcohol.
c. healthy but underweight.
d. microcephalic and cognitively impaired.

Answer 2

ANS: D

Fetal alcohol syndrome is the result of alcohols inhibiting fetal development in the first trimester. The fetus of
a woman who drinks that much alcohol will probably have this disorder. Alcohol use during pregnancy is not likely to produce the findings listed in the distractors.

Question 3

A patient was admitted last night with a hip fracture sustained in a fall while intoxicated. The patient points
to the Bucks traction and screams, Somebody tied me up with ropes. The patient is experiencing:

a. an illusion.
b. a delusion.
c. hallucinations.
d. hypnagogic phenomenon.

Answer 3

ANS: A

The patient is misinterpreting a sensory perception when seeing a noose instead of traction. Illusions are common in early withdrawal from alcohol. A delusion is a fixed, false belief. Hallucinations are sensory
perceptions occurring in the absence of a stimulus. Hypnagogic phenomena are sensory disturbances that occur
between waking and sleeping.

Question 4

A patient was admitted 48 hours ago for injuries sustained while intoxicated. The patient is shaky, irritable, anxious, and diaphoretic. The pulse rate is 130 beats per minute. The patient shouts, Snakes are crawling on my bed. Ive got to get out of here. What is the most accurate assessment of the situation? The patient:

a. is attempting to obtain attention by manipulating staff.
b. may have sustained a head injury before admission.
c. has symptoms of alcohol withdrawal delirium.
d. is having a recurrence of an acute psychosis.

Answer 4

ANS: C

Symptoms of agitation, elevated pulse, and perceptual distortions point to alcohol withdrawal delirium, a medical emergency. The findings are inconsistent with manipulative attempts, head injury, or functional
psychosis.

Question 5

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?

a. Disturbed sensory perception
b. Ineffective coping
c. Ineffective denial
d. Risk for injury

Answer 5

ANS: D

Clouded sensorium, agitation, sensory perceptual distortions, and poor judgment increase the risk for injury. Disturbed sensory perception is an applicable diagnosis, but safety has a higher priority. The scenario does not provide data to support the other diagnoses.

Question 6

A patient admitted yesterday for injuries sustained while intoxicated believes the window blinds are snakes trying to get into the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?

a. Monoamine oxidase inhibitor, such as phenelzine (Nardil)
b. Phenothiazine, such as thioridazine (Mellaril)
c. Benzodiazepine, such as lorazepam (Ativan)
d. Narcotic analgesic, such as morphine

Answer 6

ANS: C

This patient is experiencing alcohol withdrawal delirium. Sedation allows for the safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index
and anticonvulsant properties. Antidepressant, antipsychotic, and opioid medications will not relieve the patients symptoms.

Question 7

A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?

a. Check the patient every 15 minutes.
b. Rigorously encourage fluid intake.
c. Provide one-on-one supervision.
d. Keep the room dimly lit.

Answer 7

ANS: C

This patient is experiencing alcohol withdrawal delirium. One-on-one supervision is necessary to promote
physical safety until sedation reduces the patients feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes illusions. Oral fluids are important, but safety is a higher priority.

Question 8

A patient with a history of daily alcohol abuse says, Drinking helps me cope with being a single parent. Which response by the nurse would help the individual conceptualize the drinking more objectively?

a. Sooner or later, alcohol will kill you. Then what will happen to your children?
b. I hear a lot of defensiveness in your voice. Do you really believe this?
c. If you were coping so well, why were you hospitalized again?
d. Tell me what happened the last time you drank.

Answer 8

ANS: D

The individual is rationalizing. The correct response will help the patient see alcohol as a cause of the problems, not the solution. This approach can also help the patient become receptive to the possibility of
change. The incorrect responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurses frustration with the patient.

Question 9

A patient asks for information about Alcoholics Anonymous (AA). Which is the nurses best response?

a. It is a self-help group with the goal of sobriety.
b. It is a form of group therapy led by a psychiatrist.
c. It is a group that learns about drinking from a group leader.
d. It is a network that advocates strong punishment for drunk drivers.

Answer 9

ANS: A

AA is a peer support group for recovering alcoholics. The goal is to maintain sobriety. Neither professional nor peer leaders are appointed.

Question 10

Police bring a patient to the emergency department after an automobile accident. The patient is ataxic with
slurred speech and mild confusion. The blood alcohol level is 400 mg/dl (0.40 mg %). Considering the relationship between behavior and blood alcohol level, which conclusion can the nurse draw? The patient:

a. rarely drinks alcohol.
b. has a high tolerance to alcohol.
c. has been treated with disulfiram (Antabuse).
d. has recently ingested both alcohol and sedative drugs.

Answer 10

ANS: B

A nontolerant drinker would be in a coma with a blood alcohol level of 400 mg/dl (0.40 mg %). The fact that the patient is walking and talking shows a discrepancy between blood alcohol level and expected behavior. It strongly suggests that the patients body has become tolerant to the drug. If disulfiram and alcohol are ingested together, then an entirely different clinical picture would result. The blood alcohol level gives no information
about the ingestion of other drugs.

Question 11

A patient admitted to an alcoholism rehabilitation program says, Im 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?
a. Rationalization
b. Introjection
c. Projection
d. Denial

Answer 11

ANS: D

Minimizing ones drinking is a form of denial of alcoholism. The patients own description indicates that social
drinking is not an accurate name for the behavior. Projection involves blaming another for ones faults or problems. Rationalization involves making excuses. Introjection involves taking a quality into ones own
system.

Question 12

A new patient in an alcoholism rehabilitation program says, Im 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?

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?

Answer 12

ANS: D

The answer summarizes and validates what the patient reported but is accepting rather than strongly
confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in treatment.

Question 13

During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says,
After discharge, Im sure everything will be just fine. Which remark by the nurse will be most helpful to the
spouse?

a. It is good that youre supportive of your spouses sobriety and want to help maintain it.
b. Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol.
c. It will be important for you to structure life to avoid as much stress as possible. You will need to provide
social protection.
d. Remember that alcoholism is a disorder of self-destruction. You will need to observe your spouses behavior
carefully.

Answer 13

ANS: B

During recovery, patients identify and use alternative coping mechanisms to reduce their reliance on alcohol.
Physical adaptations must occur. Emotional responses, formerly dulled by alcohol, are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who should be given anticipatory guidance and accurate information.

Question 14

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?

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.

Answer 14

ANS: A

Dual diagnosis (co-occurring disorders) clinical practice guidelines for both outpatient and inpatient settings
suggest that the substance disorder and the psychiatric disorder should both be considered primary and receive
simultaneous treatments. Residential treatment may or may not be effective.

Question 15

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

a. Empathetic, supportive
b. Strong, confrontational
c. Skeptical, guarded
d. Cool, distant

Answer 15

ANS: A

Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the
early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety
and cause the patient to cling to defenses.

Question 16

A patient comes to an outpatient appointment obviously intoxicated. The nurse should:

a. explore the patients reasons for drinking today.
b. arrange admission to an inpatient psychiatric unit.
c. coordinate emergency admission to a detoxification unit.
d. tell the patient, We cannot see you today because youve been drinking.

Answer 16

ANS: D

One cannot conduct meaningful therapy with an intoxicated patient. The patient should be taken home to recover and then make another appointment. Hospitalization is not necessary.

Question 17

When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After one year
of drinking, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?

a. Tolerance develops.
b. The alcohol is less potent.
c. Antagonistic effects occur.
d. Hypomagnesemia develops.

Answer 17

ANS: A

Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the
alcohol is stable. Neither hypomagnesemia nor antagonistic effects would account for this change.

Question 18

Which statement most accurately describes substance addiction?

a. It is a lack of control over use. Tolerance, craving, and withdrawal symptoms occur when intake is reduced
or stopped.
b. It occurs when psychoactive drug use interferes with the action of competing neurotransmitters.
c. Symptoms occur when two or more drugs that affect the central nervous system (CNS) have additive effects.
d. It involves using a combination of substances to weaken or inhibit the effect of another drug.

Answer 18

ANS: A

Addiction involves a lack of control over substance use, as well as tolerance, craving, and withdrawal symptoms when intake is reduced or stopped.

Question 19

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

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.

Answer 19

ANS: C

The symptoms given in the question are consistent with narcotic withdrawal and result from administration of
naloxone. Early symptoms of narcotic withdrawal are flulike in nature. Seizures are more commonly observed
in alcohol withdrawal syndrome.

Question 20

In the emergency department, a patients 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.

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.

Answer 20

ANS: A

Hydromorphone (Dilaudid) is an opiate drug. The correct answer is the only one that relates to the patients physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated.
The distractors are desired outcomes later in the plan of care.

Question 21

Select the nursing intervention necessary after administering naloxone (Narcan) to a patient experiencing an opiate overdose.

a. Monitor the airway and vital signs every 15 minutes.
b. Insert a nasogastric tube and test gastric pH.
c. Treat hyperpyrexia with cooling measures.
d. Insert an indwelling urinary catheter.

Answer 21

ANS: A

Narcotic antagonists such as naloxone quickly reverse CNS depression; however, because the narcotics have a longer duration of action than antagonists, the patient may lapse into unconsciousness or require respiratory support again. The incorrect options are measures unrelated to naloxone use.

Question 22

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
nurses drug use was evident?

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.

Answer 22

ANS: B

The nurse intent on diverting drugs for personal use often attempts to isolate him- or herself from peers rather
than being sociable. The person seeks access to medications. Usually, the person will blame errors on others rather than accepting responsibility.

Question 23

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?

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.

Answer 23

ANS: A

Enabling denies the seriousness of the patients problem or supports the patient as he or she shifts responsibility
from self to circumstances. The incorrect options are therapeutic and appropriate.

Question 24

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

a. One-week detoxification program
b. Long-term outpatient therapy
c. Twelve-step self-help program
d. Residential program

Answer 24

ANS: D

Residential programs and therapeutic communities have goals of complete change in lifestyle, abstinence from
drugs, elimination of criminal behaviors, development of employable skills, self-reliance, and honesty. Residential programs are more effective than outpatient programs for patients with antisocial tendencies.

Question 25

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

a. Powerlessness
b. Disturbed thought processes
c. Ineffective thermoregulation
d. Impaired oral mucous membrane

Answer 25

ANS: B

Both types of patients commonly experience paranoid delusions; thus, the nursing diagnosis of Disturbed
thought processes is appropriate for both. The incorrect options are not specifically applicable to both.

Question 26

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

a. Make physical contact by frequently touching the patient.
b. Offer intellectual activities requiring concentration.
c. Avoid manipulation by denying the patients requests.
d. Observe for depression and suicidal ideation.

Answer 26

ANS: D

Rebound depression occurs with the withdrawal from CNS stimulants, probably related to neurotransmitter depletion. Touch may be misinterpreted if the patient is experiencing paranoid tendencies. Concentration is impaired during withdrawal. Denying requests is inappropriate; maintaining established limits will suffice.

Question 27

Which assessment findings best correlate to the withdrawal from central nervous system depressants?

a. Dilated pupils, tachycardia, elevated blood pressure, elation
b. Labile mood, lack of coordination, fever, drowsiness
c. Nausea, vomiting, diaphoresis, anxiety, tremors
d. Excessive eating, constipation, headache

Answer 27

ANS: C

The symptoms of withdrawal from various CNS depressants are similar. Generalized seizures are possible.

Question 28

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?

a. Substance abuse
b. Substance addiction
c. Substance intoxication
d. Recreational use of a social drug

Answer 28

ANS: B

Nicotine meets the criteria for a substance, the criterion for addiction (tolerance) is present, and withdrawal symptoms are noted with abstinence or a reduction of the dose. The scenario does not meet the criteria for substance abuse, intoxication, or recreational use of a social drug.

Question 29

Which assessment findings will the nurse expect in an individual who has just injected heroin?

a. Anxiety, restlessness, paranoid delusions
b. Heightened sexuality, insomnia, euphoria
c. Muscle aching, dilated pupils, tachycardia
d. Drowsiness, constricted pupils, slurred speech

Answer 29

ANS: D

Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations are decreased, and attention is
impaired. The incorrect options describe behaviors consistent with amphetamine use, symptoms of narcotic
withdrawal, and cocaine abuse.

Question 30

A newly hospitalized patient has needle tracks on both arms. A friend states that the patient uses heroin daily but has not used in the past 24 hours. The nurse should assess the patient for:

a. slurred speech, excessive drowsiness, and bradycardia.
b. paranoid delusions, tactile hallucinations, and panic.
c. runny nose, yawning, insomnia, and chills.
d. anxiety, agitation, and aggression.

Answer 30

ANS: C

Early signs and symptoms of narcotic withdrawal resemble symptoms of onset of a flulike illness, but without temperature elevation. The incorrect options reflect signs of intoxication or CNS depressant overdose and CNS stimulant or hallucinogen use.

Question 31

A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled pentobarbital sodium. What is the nurses first action?

a. Test reflexes
b. Check pupils
c. Initiate vomiting
d. Establish a patent airway

Answer 31

ANS: D

Pentobarbital sodium is a barbiturate. Maintaining a patent airway is the priority when the patient is unconscious. Assessing neurologic function by testing reflexes and checking pupils can wait. Vomiting should
not be induced when a patient is unconscious because of the danger of aspiration.

Question 32

An adult in the emergency department states, I feel restless. Everything I look at wavers. Sometimes Im
outside my body looking at myself. I hear colors. I think Im losing my mind. Vital signs are slightly elevated. The nurse should suspect a:

a. cocaine overdose.
b. schizophrenic episode.
c. phencyclidine (PCP) intoxication.
d. D-lysergic acid diethylamide (LSD) ingestion.

Answer 32

ANS: D

The patient who has ingested LSD often experiences synesthesia (visions in sound), depersonalization, and
concerns about going crazy. Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. PCP use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

Question 33

In what significant ways is the therapeutic environment different for a patient who has ingested D-lysergic acid diethylamide (LSD) than for a patient who has ingested phencyclidine (PCP)?

a. For LSD ingestion, one person stays with the patient and provides verbal support. For PCP ingestion, a
regimen of limited contact with staff members is maintained, and continual visual monitoring is provided.
b. For PCP ingestion, the patient is placed on one-on-one intensive supervision. For LSD ingestion, a regimen
of limited interaction and minimal verbal stimulation is maintained.
c. For LSD ingestion, continual moderate sensory stimulation is provided. For PCP ingestion, continual high-
level stimulation is provided.
d. For LSD ingestion, the patient is placed in restraints. For PCP ingestion, seizure precautions are
implemented.

Answer 33

ANS: A

Patients who have ingested LSD respond well to being talked down by a supportive person. Patients who have ingested PCP are very sensitive to stimulation and display frequent, unpredictable, and violent behaviors. Although one person should perform care and talk gently to the patient, no one individual should be alone in
the room with the patient. An adequate number of staff members should be gathered to manage violent behavior if it occurs.

Question 34

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

a. acrophobia.
b. hypothermia.
c. hallucinations.
d. anterograde amnesia.

Answer 34

ANS: D

Flunitrazepam is known as the date rape drug. It produces disinhibition and a relaxation of voluntary muscles, as well as anterograde amnesia for events that occur. The other options do not reflect symptoms commonly
observed after use of this drug.

Question 35

A patient is admitted in a comatose state after ingesting 30 capsules of pentobarbital sodium. A friend of the patient says, Often my friend drinks, along with taking more of the drug than is prescribed. What is the effect of the use of alcohol with this drug?

a. The drugs metabolism is stimulated.
b. The drugs effect is diminished.
c. A synergistic effect occurs.
d. There is no effect.

Answer 35

ANS: C

Both pentobarbital and alcohol are CNS depressants and have synergistic effects. Taken together, the action of each would potentiate the other.

Question 36

Which medication is the nurse most likely to see prescribed as part of the treatment plan for both a patient in an alcoholism treatment program and a patient in a program for the treatment of opioid addiction?

a. methadone (Dolophine)
b. bromocriptine (Parlodel)
c. disulfiram (Antabuse)
d. naltrexone (Revia)

Answer 36

ANS: D

Naltrexone is useful for treating both opioid and alcohol addictions. As an opioid antagonist, it blocks the
action of opioids. Because it blocks the mechanism of reinforcement, it also reduces or eliminates alcohol craving.

Question 37

Select the most appropriate outcome for a patient completing the fourth alcohol detoxification program in
one year. Before discharge, the patient will:

a. use rationalization in healthy ways.
b. state, I see the need for ongoing treatment.
c. identify constructive outlets for expression of anger.
d. develop a trusting relationship with one staff member.

Answer 37

ANS: B

The answer refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not provide enough information to know whether anger has been
identified as a problem. A trusting relationship, although desirable, would not help the patient maintain sobriety.

Question 38

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

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?

Answer 38

ANS: B

Learning when the patient had the last drink is essential to knowing when to begin to observe for symptoms of
withdrawal. The other questions are relevant but of lower priority.

Question 39

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

a. Chronic low self-esteem
b. Situational low self-esteem
c. Disturbed personal identity
d. Ineffective health maintenance

Answer 39

ANS: A

Low self-esteem is present when a patient sees himself or herself as inadequate. It is a chronic problem because it is a lifelong feeling for the patient. Data are not present to support the other options.

Question 40

Which documentation indicates that the treatment plan for a patient in an alcohol treatment program was
effective?

a. Is abstinent for 10 days and states, I can maintain sobriety one day at a time. Spoke with employer, who is
willing to allow the patient to return to work in three weeks.
b. Is abstinent for 15 days and states, My problems are under control. Plans to seek a new job where co-
workers will not know history.
c. Attends AA daily; states many of the members are real alcoholics and says, I may be able to help some of
them find jobs at my company.
d. Is abstinent for 21 days and says, I know I cant handle more than one or two drinks in a social setting.

Answer 40

ANS: A

The answer reflects the AA beliefs. The incorrect options each contain a statement that suggests early relapse.

Question 41

Which assessment findings support a nurses suspicion that a patient has been using inhalants?

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

Answer 41

ANS: D

Inhalants are usually CNS depressants, giving rise to confusion and ataxia. Mouth ulcers come from the
irritation of buccal mucosa by the inhalant. The incorrect options relate to cocaine snorting and opioid abuse.

Question 42

A patient undergoing alcohol rehabilitation decides to accept disulfiram (Antabuse) therapy to avoid impulsively responding to drinking cues. Which information should be included in the discharge teaching for
this patient? Select all that apply.

a. Avoid aged cheeses.
b. Read labels of all liquid medications.
c. Wear sunscreen and avoid bright sunlight.
d. Maintain an adequate dietary intake of sodium.
e. Avoid breathing fumes of paints, stains, and stripping compounds.

Answer 42

ANS: B, E

The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne; smelling alcohol-laden fumes; and eating foods prepared with wine, brandy,
beer, or spirits of any sort may also trigger reactions. The other options do not relate to hidden sources of alcohol.

Question 43

A nurse can assist a patient diagnosed with addiction and the patients family in which aspects of relapse prevention? Select all that apply.

a. Rehearsing techniques to handle anticipated stressful situations
b. Advising the patient to accept residential treatment if relapse occurs
c. Assisting the patient to identify life skills needed for effective coping
d. Isolating self from significant others and social situations until sobriety is established
e. Teaching the patient about the physical changes to expect as the body adapts to functioning without
substances

Answer 43

ANS: A, C, E

Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals.
Anticipatory problem solving and role playing are good ways of rehearsing effective strategies for handling stressful situations. The nurse can participate in role playing and help the patient evaluate the usefulness of
new strategies. The nurse can also provide valuable information about the physiologic changes that can be
expected and the ways in which to cope with these changes. Residential treatment is not usually necessary after
relapse. Patients need the support of friends and family to establish and maintain sobriety.

Question 44

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

a. Administration of naloxone (Narcan)
b. Vitamin B12 and folate supplements
c. Restoring nutritional integrity
d. Prevention of seizures
e. Reduction of fever

Answer 44

ANS: D, E

Hyperpyrexia and convulsions are common when a patient has overdosed on a CNS stimulant. These problems are life threatening and take priority. Naloxone (Narcan) is administered for opiate overdoses. Vitamin B12
and folate may be helpful for overdoses from solvents, gases, or nitrates. Nutrition is not a priority in an overdose situation.