Chapter 23. Substance-Related and Addictive Disorders

1) What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?

A. Risk for injury R/T central nervous system stimulation

B. Disturbed thought processes R/T tactile hallucinations

C. Ineffective coping R/T powerlessness over alcohol use

D. Ineffective denial R/T continued alcohol use despite negative consequences

2. A nurse evaluates a client’s patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance use disorder?

A. Narcotic pain medication is contraindicated for all clients with active substance-use problems.

B. Clients who are regularly using alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control.

C. There is no need to assess the client for substance use disorder. There is an obvious PCA malfunction.

D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

3. On the first day of a client’s alcohol detoxification, which nursing intervention should take priority?

A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days.

B. Educate the client about the biopsychosocial consequences of alcohol abuse.

C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.

D. Administer vitamin B₁ to prevent Wernicke-Korsakoff syndrome.

4. Which client statement indicates a knowledge deficit related to substance use?

A. “Although it’s legal, alcohol is one of the most widely abused drugs in our society.”

B. “Tolerance to heroin develops quickly.”

C. “Flashbacks from LSD use may reoccur spontaneously.”

D. “Marijuana is like smoking cigarettes. Everyone does it. It’s essentially harmless.”

5. A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual’s situation?

A. The individual is experiencing psychological addiction.

B. The individual is experiencing physical addiction.

C. The individual is experiencing substance addiction.

D. The individual is experiencing social addiction.

6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal?

A. Antagonist therapy

B. Deterrent therapy

C. Codependency therapy

D. Substitution therapy

7. A client diagnosed with chronic alcohol use disorder is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching?

A. After discharge, the client will immediately attend 90 AA meetings in 90 days.

B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings.

C. After discharge, the client will incorporate family in AA attendance.

D. After discharge, the client will seek appropriate deterrent medications through AA.

8. A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediately report to the ED physician?

A. Antecubital bruising

B. Blood pressure of 180/100 mm Hg

C. Mood rating of 2/10 on numeric scale

D. Dehydration

9. Which client statement demonstrates positive progress toward recovery from a substance use disorder?

A. “I have completed detox and therefore am in control of my drug use.”

B. “I will faithfully attend Narcotic Anonymous (NA) when I can’t control my cravings.”

C. “As a church deacon, my focus will now be on spiritual renewal.”

D. “Taking those pills got out of control. It cost me my job, marriage, and children.”

10. A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse’s rationale for this intervention?

A. To assess for emotional strength

B. To assess for Wernicke-Korsakoff syndrome

C. To assess for tachycardia

D. To assess for fine tremors

11. Upon admission for symptoms of alcohol withdrawal, a client states, “I haven’t eaten in 3 days.” Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis?

A. Knowledge deficit

B. Fluid volume excess

C. Imbalanced nutrition: less than body requirements

D. Ineffective individual coping

12. A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient drug rehabilitation program. Which client statement should a nurse associate with a positive prognosis for this client?

A. “I’m not going to use heroin ever again. I know I’ve got the willpower to do it this time.”

B. “I cannot control my use of heroin. It’s stronger than I am.”

C. “I’m going to get all my children back. They need their mother.”

D. “Once I deal with my childhood physical abuse, recovery should be easy.”

13. A client’s wife has been making excuses for her alcoholic husband’s work absences. In family therapy, she states, “I just need to work harder to get him there on time.” Which is the appropriate nursing response?

A. “Why do you assume responsibility for his behaviors?”

B. “Codependency is a typical behavior of spouses of alcoholics.”

C. “Your husband needs to deal with the consequences of his drinking.”

D. “Do you understand what the term ‘enabler’ means?”

14. Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines?

A. Haloperidol (Haldol) and fluoxetine (Prozac)

B. Carbamazepine (Tegretol) and donepezil (Aricept)

C. Disulfiram (Antabuse) and lorazepam (Ativan)

D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

15. During group therapy, a client diagnosed with alcohol use disorder states, “I would not have boozed it up if my wife hadn’t been nagging me all the time to get a job. She never did think that I was good enough for her.” How should a nurse interpret this statement?

A. The client is using denial by avoiding responsibility.

B. The client is using displacement by blaming his wife.

C. The client is using rationalization to excuse his alcohol dependence.

D. The client is using reaction formation by appealing to the group for sympathy.

16. A nurse is interviewing a client in an outpatient drug treatment clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish?

A. The client will identify one person to turn to for support.

B. The client will give up all old drinking buddies.

C. The client will be able to verbalize the effects of alcohol on the body.

D. The client will correlate life problems with alcohol use.

17. A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur?

A. 50 mg/dL

B. 100 mg/dL

C. 250 mg/dL

D. 300 mg/dL

18. A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family, who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms?

A. Between 3 a.m. and 11 a.m.

B. Shortly after a 24-hour period

C. At the beginning of the third day

D. Withdrawal is individualized and cannot be predicted.

19. A client diagnosed with depression and substance use disorder has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions?

A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance.

B. Sedative-hypnotics are expensive and have numerous side effects.

C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep.

D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

20. A client with a history of insomnia has been taking chlordiazepoxide (Librium), 15 mg, at night for the past year. The client currently reports that this dose is no longer helping him fall asleep. Which nursing diagnosis appropriately documents this problem?

A. Ineffective coping R/T unresolved anxiety AEB substance abuse

B. Anxiety R/T poor sleep AEB difficulty falling asleep

C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep

D. Risk for injury R/T addiction to Librium

21. A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess?

A. Gross tremors, delirium, hyperactivity, and hypertension

B. Disorientation, peripheral neuropathy, and hypotension

C. Oculogyric crisis, amnesia, ataxia, and hypertension

D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

22. A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse?

A. Alcohol poisoning

B. Cardiovascular accident (CVA)

C. A reaction to disulfiram (Antabuse)

D. A reaction to tannins in the red wine

23. A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse?

A. “This medication will help you maintain your abstinence.”

B. “This medication will cause uncomfortable symptoms if you combine it with alcohol.”

C. “This medication will decrease the effect alcohol has on your body.”

D. “This medication will lower your risk of experiencing a complicated withdrawal.”

24. A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication?

A. “Only oral ingestion of alcohol will cause a reaction when taking this drug.”

B. “It is safe to drink beverages that have only 12% alcohol content.”

C. “This medication will decrease your cravings for alcohol.”

D. “Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug.”

25. Which is the priority nursing intervention for a client admitted for acute alcohol intoxication?

A. Darken the room to reduce stimuli in order to prevent seizures.

B. Assess aggressive behaviors in order to intervene to prevent injury to self or others.

C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system.

D. Teach the negative effects of alcohol on the body.

26. A client diagnosed with alcohol use disorder joins a community 12-step program and states, “My life is unmanageable.” How should the nurse interpret this client’s statement?

A. The client is using minimization as an ego defense.

B. The client is ready to sign an Alcoholics Anonymous contract for sobriety.

C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous.

D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

27. In assessing a client with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention?

A. Dextroamphetamine (Dexedrine)

B. Diazepam (Valium)

C. Morphine (Astramorph)

D. Phencyclidine (PCP)

28. The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility?

A. By asking directly if the client has ever had a problem with alcohol

B. By holistically assessing the client, using the CIWA scale

C. By using a screening tool such as the CAGE questionnaire

D. By referring the client for physician evaluation

29. Which of the following nursing statements exemplify important insights that will promote effective intervention with clients diagnosed with substance use disorders? Select all that apply.

A. “I am easily manipulated and need to work on this prior to caring for these clients.”

B. “Because of my father’s alcoholism, I need to examine my attitude toward these clients.”

C. “Drinking is legal, so the diagnosis of substance use disorder is an infringement on client rights.”

D. “Opiate addicts are typically uneducated, unrefined individuals who will need a lot of education and social skills training.”

E. “I can fix clients diagnosed with substance use disorders as long as I truly care about them.”